Appendix

Appendix

Main Diseases, Procedures, and Products

Main diseases 1 2Main scopes used in ESD

Gastrointestinal videoscopes are for viewing the stomach and duodenum
through the esophagus and usually have an insertion tube length of
1,030mm. Videoscopes have a forward-facing lens on the distal tip which
is ideal for observing tissue directly in front of the endoscope. Videoscopes
designed to be inserted through the mouth typically have an insertion tube
diameter of around 10mm; videoscopes designed for passage through thenose are about half that diameter.

GI: Digestive Tract (Esophagus/Stomach/Large Intestine/Small Intestine)
Main diseases 1

Esophageal Cancer

The walls of the esophagus are made from multiple layers of mucosa and muscle.
Cancer of the esophagus typically occurs in the innermost mucosa. This is called“ squamous cell carcinoma ”and over 90% of Japanese people with cancer of theesophagus have this type of cancer. Habitual drinking and smoking are sources ofrisk. There is another type of esophageal cancer called“ adenocarcinoma ”which
is more common in Europe and the U.S. This type of cancer is found in 60-70%
of esophageal cancer cases in Europe and the U.S. The primary cause of
adenocarcinoma is a condition called Barrett's esophagus, where stomach acidflows up the esophagus and causes inflammation of the esophageal mucosa.

Main diseases 2

Stomach Cancer

It is thought to arise in the mucosas of the stomach from gastritis and atrophy.
When atrophy occurs in the mucosas of the stomach, it leads to atrophic gastritis,which can lead to“ intestinal metaplasia, ”a condition in which the stomach-type
mucosa turns into intestinal-type mucosa. Intestinal metaplasia is known todevelop into cancer. Recently it has been shown that this is related to thebacterium Helicobacter pylori. H. pylori causes inflammation of the mucosa in thestomach and has been observed to lead to atrophic gastritis and intestinal
metaplasia.

Esophagus

Main diseases 3 4Main scopes used in ESD
Orifice ofthe stomach
Lessercurvatureof thePylorus stomach

Main diseases 5
Main scopes used in ESD

Ascending colon

Transverse colon

Descendingcolon

Main diseases 5

24

Small intestine
Duodenum Jejunum and ileum

Small Intestinal Ulcer

An ulcer that appears in the small intestine. Frequency of occurrence is not high,with less than a 5% chance overall of becoming a gastrointestinal tumor, however,malignancy is high since two-thirds of all small intestinal ulcers are malignant
tumors. These ulcers are mainly discovered when examining such symptoms as
pain, bleeding, or stricture of the abdomen. Although early diagnosis is difficult,through the improvement of endoscope technology, such as capsule endoscopes
and balloon endoscopes, which enable detailed examination of the small intestine,
small intestinal tumors are being discovered with greater frequency.

This involves using an endoscope with a balloon attached on the distal
end such that the inflated balloon holds the intestine open and allows theendoscope to be moved forward. Insertion can be via either the mouth oranus. As the instrument channel outlet is also provided, as on aconventional endoscope, it can be used for biopsies or to perform simple
procedures. To be long enough to view the small intestine, the endoscope
has a length of 2,000mm and a diameter of approximately 9mm.

Small intestinal
videoscopeSingle balloon
enteroscope

Ultrasoundgastrovideoscope

Ultrasound image

RectumColon PolypA tissue that protrudes from the mucous membrane of the colon is called a colon
polyp. The polyp has a high probability of occurring in the rectum or the sigmoid
colon, and its size is between a few millimeters and 3cm. They are largely divided
into neoplastic and non-neoplastic polyps. Small polyps are generally
asymptomatic, but if they become large, symptoms such as fecal occult bloodand fresh blood in the stool can occur.

Small Intestinal Scope

Sigmoidcolon

Large intestine

Main diseases 4

ColonovideoscopeGreatercurvatureof thestomachLarge Intestine Cancer

It is increasing in Japanese people as they are starting to eat a more Western
diet. Cancer of the large intestine includes both colon cancer and rectal cancer,
but colon cancer especially is increasing rapidly. Consuming animal fats causes
greater secretion of biliary acid to help with digestion. There are carcinogens
among the substances that develop when digesting fats. It is believed that cancer
occurs in the mucosa of the large intestine.
The inside of the large intestine consists of four layers. Sometimes, benign
polyps called adenomas occur in the mucosa. Many cases of colorectal cancer
are believed to be related to these polyps. Furthermore, it has been recently
discovered that there are also flat and depressed cancers that develop directlyfrom the mucosa. The most common areas for colorectal cancer are the rectumand sigmoid colon, which cancers account for about 70% of all cases.

Gastrointestinal
videoscope

Colonoscope

Colonovideoscopes are longer than gastrointestinal videoscopes in orderto accommodate the long 1.5m length of the adult large intestine.
Standard-length colonovideoscopes are 1,330mm long. Extended length
models are 1,680mm long. The colonovideoscope has a forward-facing
tip. In order to facilitate insertability into the colon a flexibility adjustmentring allows the operator to adjust the stiffness of the insertion section
during the procedure. Colonovideoscopes typically have an insertion tube
diameter of around 13mm.

StomachMain diseases 3

Gastrointestinal Scope

Ultrasound Gastrovideoscope
In addition to regular endoscopes, Olympus manufactures“ ultrasoundvideoscopes ”that allow combined endoscopic imaging and ultrasoundimaging of the organ under inspection. They have an ultrasound transducer
installed on their tip. By using medical ultrasound technology, lesions thatcannot be seen from the surface and are located deep in the organ can befound. In the digestive tract, this kind of endoscope is used to find tumorsand cancers hidden below the surface of the GI tract and to examine
varices in the esophagus. They are also used to find cancer, gallstones
and pancreatic stones in the pancreas and biliary tract. Biopsy needles
inserted under ultrasound guidance can diagnose hidden submucosal
tumors and diagnose and treat pancreatic cysts.

Small intestine and surrounding organs

25

Appendix

Appendix

ENDO-AID, an Endoscopy CAD*1 Platform Equippedwith an AI-powered Diagnostic Support Application
for Colonoscopies

Method of treatment in internal medicine

regarding main diseases 4

Polypectomy

A polypectomy is a procedure that removes local elevated lesions called polyps
which grow out of the mucous epithelium. A wire snare is looped around the baseof the polyp, and a high-frequency electrical current is applied while the snare istightened. The polyp is then burned off and collected using gripping forceps.
There is also a method called“ cold polypectomy, ”in which polyps of less than
10mm are squeezed and removed without applying high-frequency current.

When used in combination with the EVIS X1 gastrointestinal endoscopy
system, ENDO-AID serves as a CAD platform that can automatically detectand display possible lesions such as polyps and cancer in real time. By
adding AI-powered support, ENDO-AID makes colonoscopies easier forboth physician and patient and aims to improve overall clinical results
regardless of the doctor's experience. Equipped with ENDO-AID CADe* 2,
a detection support application for lesions in the large intestine.

Main endotherapy devices used in TSD
ENDO-AIDElectrosurgical Snare

Polypectomy

Electrosurgical snare

Hot biopsy

Hot biopsy forceps

EMRC method

Clear cap

An electrosurgical snare is forceps made of looped metal wire. The therapeutic
device applies a high-frequency current to ligate the lesion site and then burn off
the lesion. Among high-frequency snares are ones that can carry out a cold
polypectomy that severs the lesion without applying a high-frequency current.

ENDOCUFF VISION, Colonoscope Distal Attachment
This device is attached to the colonoscope ’s distal end to support
visualization in procedures such as colonoscopy screening and polypremoval. ENDOCUFF VISION features a proprietary design comprised of aflexible arm with extensions placed on the device circumference. The arms
open the colon ’s bended section and mucosal folds, providing a clearerview inside the colon and making it easier to detect polyps and adenomas.
Research* 3 shows that compared with standard colonoscopies, those
performed using this technology increase the adenoma detection rate(ADR) by up to 11%. According to this research, each 1% improvement in
the ADR lowers the risk of colon cancer by 3%.

Method of treatment in internal medicine

regarding main diseases 4

For small polyps and relatively flat (sessile) polyps, a procedure called a biopsy
can be performed. While pinching the polyp with a biopsy forceps, high-frequency
current is used to remove the tissue and cauterize the polyp base, preventing
bleeding from the site.
ENDOCUFF VISION

Main endotherapy devices used in TSD*1 Computer Aided Detection/Diagnosis: AI-powered diagnostic and detection support*2 Computer Aided Detection: AI-powered detection support*3	Williet, N., Tournier, Q., et al. Effect of Endocuff-assisted colonoscopy on adenoma detection rate: meat-analysis of randomized controlled trials. Endoscopy, 50 (9), 846-860. Doi:10.1055/
a0577-3500. Available at: https://www.ncbi.nlm.nih.gov/pubmed/29698990

Diagnostic method
regarding main diseases 1 2 3 4 5

regarding main diseases 1 2 3 4Endoscopic Mucosal
Resection (EMR)

EMR enables the removal of small flat lesions such as early-stage cancers. There
are several techniques for performing EMR. One of these is so-called“ cap EMR ”(EMRC). This procedure uses a transparent plastic cap fitted over the tip of theendoscope. The lesion is first raised by injecting normal saline into the submucosa
under the lesion. The raised tissue is then sucked into the cap attached to the tipof the endoscope and is cut off using an electrosurgical snare positioned inside
the cap. The lesion is then recovered using suction.

Biopsy Forceps

Biopsy forceps include the standard type and also a type with a needle which
prevents slipping on the surface of mucosa. Various biopsy forceps are used suchas a single-side opening type for the esophagus and the wide-opening type used
for stiff mucosa.

Hot Biopsy Forceps

Hot biopsy forceps can collect tissue while applying a high-frequency current to acup unit. The end section is about the same structure as a biopsy forceps. The
operating section has a plug for connecting to an electrosurgical generator.

Method of treatment in internal medicine

BiopsyA biopsy is a diagnostic procedure that removes pieces of tissue which issuspected of being a lesion, subject to pathological testing under a microscope.

Main endotherapy devices used in TSD

Hot Biopsy

BiopsyBiopsy forceps withneedleMain endotherapy devices used in TSD

Clear Cap

Equipped with a scope end-section, clear cap is used to remove a lesion bysuction.

Diagnostic method
regarding main diseases 1 2 3 4 5

Dye Spraying

In order to identify tumors or other lesions in the early stages, dye, such as
Indigo carmine solution and Lugol iodine solution, is sprayed on the surface ofthe mucosa. This procedure enables easier observation of mucosal surface
shape change.
Main endotherapy devices used in TSD

Spraying Tube

An endotherapy device for spraying dye on an observation site.

26

Spraying Lugol into
the esophagus(image)Spraying tube

27

Appendix

Method of treatment in internal medicine

regarding main diseases 1 2 3Appendix

Endoscopic Submucosal
Dissection (ESD)

Main therapeutic devices used in TSD

EMR is limited to removing lesions smaller than 2cm. ESD was developed as a procedure
for removing much larger (and more irregularly shaped) lesions. First, an electrosurgicalelectrode is used to make small burn marks to outline the area around the lesion. The
lesion is then raised by injecting normal saline into the submucosa to separate the lesion
from the normal tissue below. Next, the mucosa around the lesion is cut using anelectrosurgical knife. The submucosa is then separated, and the lesion is recovered using
forceps.
Main endotherapy devices used in TSD

regarding main diseases 1 2 3 4 5Main diseases 1
ESD

Electrosurgical knife

Electrosurgical Knife

Hemostasis

regarding main diseases 2

Clip hemostasis

High-frequency
hemostatic forceps

High-Frequency Hemostatic Forceps

Laparoscopy-Assisted Distal
Gastrectomy (LADG)

This surgery is limited in application to early-stage cancers from the lower part of thestomach (pyloric antrum) to the middle of the stomach (body of the stomach). The
standard procedure is to remove at least two-thirds of the stomach and the lymph nodes
around the stomach. The reason this is called a“laparoscopy-assisted”procedure is thatthe surgery requires a laparotomy, albeit with a smaller incision.
The two basic methods for reconstructing the stomach are the Billroth I method andthe Roux-en-Y method. In the Billroth I method, the remaining stomach and theduodenum are joined. In the Roux-en-Y method, the remaining stomach and the jejunum
are joined, and the remaining duodenum is connected to the bottom of the jejunum. Foodflows from the stomach to the jejunum, where it mixes with digestive fluids that flow infrom the duodenum.
If these surgeries are not appropriate for the patient, there is still another kind of
stomach cancer surgery called Laparoscopy-Assisted Total Gastrectomy (LATG).

Main diseases 1 2Main scopes used in ESD

regarding main diseases 3

Bile duct

Gallbladder

Major duodenal
papillaPancreas

Duodenovideoscope

Side-viewing tip
design(including forceps
elevator system)

Note: A single-use scope is planned for future release.

Main diseases 1 2Main scopes used in ESD

Cholangioscope

Cholangiovideoscope is a miniature scope inserted in the instrument
channel of a duodenovideoscope. It can be used for direct observation
inside the narrow duct of the pancreaticobiliary system or to collect tissue.
Billroth I method

Roux-en-Y method

Note: A single-use scope is planned for future release.

Diagnostic method

Laparoscopy-Assisted
Colectomy

Colorectal cancer surgeries target the large intestine, cecum, and rectum. As withstomach cancer, the goal of these surgeries is to remove the affected area as well as theassociated lymph nodes. Compared to the stomach, the structure of arteries and veins
supplying the colon is simple and the removal of associated lymph nodes is easy.
Therefore, it is said that there is a high chance that laparoscopy-assisted colectomy may
become the standard surgery for colorectal cancer in the near future.

28

Hepatic duct

Duodenoscope

Unlike gastrointestinal videoscopes and colonovideoscopes,
duodenovideoscopes have a side-viewing tip design in which the lens andillumination optics are on the side of the scope. This enables the scope toperform procedures such as Endoscopic Retrograde Cholangio
Pancreatography (ERCP) that is imaging of the pancreaticobiliary ducts via
the duodenum, and for performing Endoscopic Sphincterotomy whichallows removal of gallstones via the mouth. This endoscope has a prism at
its tip to allow it to look perpendicular to its axis, and a forceps elevator todeflect accessory devices in the same direction. Duodenovideoscopes
typically are 1,240mm long.

regarding main diseases 1 2
Method of surgical treatment

Liver

Clip

Hemostatic forceps that use high-frequency securely grip large blood vessels or hard and slippery tissue, enabling coagulation to occur.

Method of surgical treatment

Pancreatic Cancer

It comes from pancreatic cells. Pancreatic cancer is divided into two types:
exocrine (digestive enzyme secretion system) and endocrine (hormone secretion
system). About 95% of pancreatic cancer is of the exocrine type, and about 85%of these are invasive pancreatic duct cancers that occur on the epithelium of thepancreatic duct. Pancreatic cancer typically occurs in individuals who are 50–70
years old, especially in elderly males.

The clip acts to pinch the open blood vessel closed, and applies pressure to the tissue tostop the bleeding. In the clip hemostasis method, the clip tip is left in place after
compression.
Main endotherapy devices used in TSD

Gallstones

A medical condition in which a stone can appear in the biliary tract (generic term
for the bile duct, gallbladder, and major duodenal papilla). Gallstones that form in
the gallbladder are particularly common. Biliary tract cancers, which can appear
in the gallbladder and bile duct, are understood to be connected to gallstones. Ifgallstones injure the biliary tract, they can cause inflammation, which can turn into
cancer if prolonged.

Main diseases 2

A hemostasis procedure is sometimes required to control the bleeding that results fromremoving polyps and other lesions. There are several ways to stop bleeding using an
endoscope.
Main endotherapy devices used in TSD

Systems used in surgery are described on
pages 36-37.

GI: Biliary Tract / Pancreas

A therapeutic device for removing larger early-stage lesions. There are knives with a ceramic insulator attached to the tip of the needle
knife. The insulator lowers the risk of perforation in the digestive tract and also enables large-scale mucosa removal.

Method of treatment in internal medicine

Surgical Systems

Cholangiovideoscope

Endoscopic Retrograde Cholangio
Pancreatography (ERCP)

ERCP is method for examining the biliary tract and pancreatic duct using a
combination of endoscopic and radiographic techniques. Using an endoscope,a thin tube (cannula) is inserted through the papilla of Vater into a duct of thepancreaticobiliary system. Radiological contrast dye is then injected into theducts, and the area is viewed using X-rays.

Laparoscopy-assisted colectomy
Note: The above image of the procedure is from the casereport by Dr. Arita of Kyoto Prefectural University of
Medicine.

Main endotherapy devices used in TSD

CannulaA thin tube for injecting radiological contrast dye into the pancreatic or bile ductthat can then be viewed by X-rays.

ERCP

Cannula29

Appendix
Method of treatment in internal medicine

regarding main diseases 1

Appendix

Endoscopic
Sphincterotomy

Urology
Main diseases 1

It is a procedure that is often used to remove gallstones. A papillotomy knife(papillotome) is inserted into the opening of the duodenal papilla, and the papillarysphincter is cut open. Following this, a stone extraction balloon or stone retrieval
basket can be inserted into the biliary ducts to remove any gallstones residing in
the biliary system.
Main endotherapy devices used in TSD

Main endotherapy devices used in TSD

Endoscopic
Sphincterotomy

Papillotome

Stone Extraction
BalloonMain diseases 3

Stone Retrieval Basket

An endotherapy device that is used to help retrieve and remove stone fragmentsfrom the bile duct.

Method of treatment in internal medicine

regarding main diseases 1

Stone extraction
balloonStone retrieval basket

When a bile duct has a stricture or blockage, this stent is inserted into the duct
and releases bile. The device is implanted for a short period of time (aroundseveral weeks).
Main endotherapy devices used in TSD

regarding main diseases 1

EBD

Plastic stent

Main diseases 1 3Main scopes used in TSD

Metal Stent

UreterBladder

Seminalgland

UrethraProstate
Testicle
Urinary system

Ureteroscope

Method of treatment

regarding main diseases 1 3

Detachment ofgallbladder

Removal throughincision

Main therapeutic devices used in TSD

Resectoscope

Transurethral Resection(TUR)

TUR is a procedure in which a surgeon inserts a resectoscope from the urethra
and then, using the handle, operates a loop-shaped electrode to surgically resect
tissue from an enlarged prostate or a bladder tumor with an electrosurgical knife.
For a safe procedure and precise resection, the solution from Olympus is the
TURis procedure, in which a resection is performed by discharging electricity fromthe entire area surrounding the electrode through saline.

Surgical Systems

Flexible bending
function

Resectoscope

Resection of the enlarged prostate when aresectoscope is inserted transurethrally
near the neck of the urinary bladderElectrosurgical
Generator

The equipment enables incision of a lesion and coagulation by connecting to an
endotherapy device and generating a high-frequency current.

30

Renal
pelvisUreteroscope / Cystoscope

A resectoscope is a rigid endoscope for diagnosing and treating theurethra and bladder. It is inserted in from the external urethral orifice andused for the surgical resection of a lesion with high-frequency current.

Laparoscopic
Cholecystectomy

Systems used in surgery are described on
pages 36-37.

KidneyNote: A single-use scope (ureteroscope) is planned for future release.

This is the most common type of endoscopic surgery in Japan. The gallbladder is
attached to the underside of the liver, and must be carefully removed using anelectrosurgical knife and dissecting forceps. Next, the cystic artery and cystic
duct are clamped with clips and cut to separate them from the liver. Finally, a
trocar is inserted and the gallbladder removed from the body through the trocar
using grasping forceps.
Main therapeutic devices used in TSD

This occurs when the urothelium becomes cancerous. While most cases (90% ormore) are categorized as urothelial cancer, rare instances of squamous cell
carcinoma and adenocarcinoma also occur. The main symptoms are bloody urine
or pain during urination.

They are used for viewing the urinary bladder through the urethra and thekidneys through the urinary duct. Olympus manufactures bothvideoscopes and fiberscopes for this application. The videoscope version
supports high-definition imaging due to its high performance CCD and isalso capable of NBI. Moreover, in order to facilitate the observation of the
bladder neck, both the Up and Down sides bending angle of 275 degrees
are realized.

This stent is made of metal mesh. The post-implantation lumen is larger than for aplastic stent and can be expected to have large drainage. Comparatively
long-term (several months) patency and detainment is possible.

Method of surgical treatment

Bladder Tumor(Bladder Cancer)

Main scopes used in TSD

Plastic Stent

Adrenalgland

Urinary Stone

Main diseases 1 2 3Endoscopic Biliary
Drainage (EBD)

If the free flow of bile to the duodenum is hindered due to gallstones or a stricture(narrowing) of the bile duct due to disease, EBD may be performed by inserting aplastic or metal stent into the duct to allow the free flow of bile.
Main endotherapy devices used in TSD

Main diseases 2

A condition in which substances contained in urine crystalize for some reason andcoalesce in the form of a stone. Typical symptoms include extreme pain, bloody
urine, or the presence of the stone in urine.

A balloon-shaped catheter used to scrape out small stones resembling sandand silt.
Main endotherapy devices used in TSD

Male

A condition in which urination is obstructed by pressure placed on the urethra by
an enlarged prostate, which is located under the bladder. Symptoms include a
sensation of residual urine and more frequent trips to the toilet due to the reduced
amount of urine passed at each urination.

Papillotome

An electrosurgical knife inserted into the papilla at the end of the bile duct for use
in incision using high frequencies.

Benign Prostate Hyperplasia(BPH)

Electrosurgical
Generator

Resectoscope andspecial-use electrode31

Appendix

Appendix

Method of treatment

regarding main diseases 1

Treatment throughNon-Ablative Device

Olympus is rolling out iTind, a minimally invasive treatment device that ensures urine flowby expanding the urethra over the span of five days after longitudinally implanting athree-wire nitinol device in the prostate. iTind enables a patient to be treated at a doctor’soffice or clinic, returning home the same day, and to achieve resolution of symptoms
without a permanent implant left behind.
Method of treatment

regarding main diseases 2

regarding main diseases 1

EBUS-TBNA(Endobronchial ultrasound transbronchial needle aspiration)

A technique mainly for the purpose of diagnosing lymph node metastasis in lungcancer. The procedure uses ultrasonic images in real time to guide the insertion of aneedle into the lymph node via the trachea and bronchus for the collection by
aspiration of cell or tissue samples. The collected samples are observed anddiagnosed in detail by pathological examinations before deciding on the next courseof treatment.

Minimally invasive
treatment device for BPH

Transurethral
Lithotripsy (TUL)

During Lithotripsy, an urologist navigates an endoscope through the urinary tract and uses
laser or ultrasonic energy to break up one or more stones in the bladder, ureter, or kidney.
The resulting stone fragments may be expelled naturally or can be removed using stone
retrieval baskets.
Main therapeutic devices used in TSD

Diagnostic method

Main endotherapy devices used in TSD

Aspiration Needle

This endotherapy device is guided by a ultrasound endoscope and is used for thecollection by aspiration of cell or tissue samples from the trachea and bronchus.

EBUS-TBNA system

EBUS bronchoscope
and aspiration needle

Cytology of bronchus

Cytology brushIntrabronchial valve
systemEndobronchial valve

Image of removing stones with stone
retrieval baskets

Thulium Fiber Laser
SystemDiagnostic method
regarding main diseases 1

This product uses superpulsed thulium fiber laser technology for the removal of stones in
the urinary tract (the kidney, ureter, bladder, and urethra) and for resection of soft tissue. It
works by breaking up the stone into tiny pieces which are then passed out of the bodyduring urination. The device helps shorten operation time by improving performance forbreaking the stones. The device is also used to treat soft tissue (such as the prostate),enabling Olympus to provide urologists with a variety of procedural solutions. The
compact size of the equipment helps to save space and make movement easier between
operating rooms.

Cytology

Cytology is performed by scrubbing a brush over a mucosa and observing thecollected cells under a microscope.
Main endotherapy devices used in TSD
Thulium fiber laser system

Cytology Brush

A brush for collecting cells from the bronchial tubes with narrow openings. The cytology
brushes are 1-5mm in diameter and less than 10mm in length.

Respiratory
Method of treatment

Main diseases 1

Lung Cancer

Lung cancer consists of malignant tumors of the bronchial tubes and pulmonary
epithelium. Instances are on the rise due to smoking and other causes. Among cancers, it
has the highest mortality rate worldwide.*

Trachea
Right lung*WHO cancer statistics: http://www.who.int/news-room/fact-sheets/detail/cancer

Main diseases 2

Emphysema

A condition caused by the over-inflation of the alveoli located at the tips of the bronchi
leading to the destruction of lung functions. It is defined as one of the forms of chronic
obstructive pulmonary disease (COPD) in which inhalation of tobacco or other harmful
substances causes inflammation of the lungs and bronchus, which in turn causes
progressive breathing difficulties.

Main diseases 1 2Main scopes used in TSD

Bronchus

A minimally invasive procedure for emphysema. The procedure reduces lung volume by
deploying a valve within the bronchial tube to close off the lung cells. Specifically, a small,umbrella-shaped valve is implanted in the lung’s upper lobe bronchus via a catheter
inserted into the instrument channel of a bronchoscope. The purpose is to redirect the
airflow from the unhealthy part of the lung to a normal section through the effects of aone-way valve used as the implanted valve.
Main endotherapy devices used in TSD

Lungs

Endobronchial Valve

This valve is a therapeutic device for emphysema. It is used when medicines have noeffect or in which neither a lung reduction procedure nor transplant surgery is notapplicable. It is also used to treat postoperative prolonged air leaks arising from apneumothorax or lung surgery.

Bronchoscope

Olympus manufactures three types of bronchoscopes for viewing the lungs andbronchial tubes: videoscopes, fiberscopes, and a“hybridscope”which has both
fiber-optic and video components. Bronchoscopes may be inserted either through themouth or the nose and can travel down to examine the smallest lumens of thebronchial tree. Videoscopes have an advantage in obtaining sharp pictures of the lungthrough their high quality CCDs. Fiberscopes have an advantage in being smaller indiameter at the tip and therefore allow for deeper insertion into the distal portion of
bronchial tubes. The hybrid type has a fiber-optic bundle in its tip and a CCD image
sensor installed in its control section. This instrument incorporates advantages of bothvideoscope and fiberscope technology, with high insertability due to its small diameter
while at the same time also producing high-quality images.
Note: In April 2021, sales started in the U.S. for Olympus’ first single-use bronchoscope.

32

regarding main diseases 2

Left lung

Bronchoscopic Lung
Volume Reduction

Method of treatment

regarding main diseases 1

Pulmonary Resection

Lung cancers are now being surgically resected using endoscopes.
Thoracoscopic partial lung resection surgery can be performed for removing
tumors smaller than 3cm in diameter, and lung lobectomies performed for treatingareas greater than 4cm in breadth.
Bronchoscope

Main therapeutic devices used in TSD

Surgical Systems
Systems used in surgery are described on
pages 36-37.

Pulmonary Resection (image)33

Appendix

Ear, Nose, and Throat (ENT)
Main diseases 1

Tympanitis

A condition in which the infection of the middle ear by bacteria, viruses, or othergerms due to a cold, etc., causing inflammation and a buildup of pus or fluid.
Symptoms include headache, dizziness hearing difficulties, or the ear feelingblocked.

Main diseases 2

Ear canal
Middle ear

Eustachian
tube

Ear
Paranasal sinuses

Sinusitis

What is commonly known as empyema is a condition resulting from inflammationof the paranasal sinus due to causes such as a common cold, hay fever, or dental
decay. It results in a blocked nose with thick colored mucus. Other symptoms
include headache and an impaired sense of smell.

Main diseases 3

Eardrum

Nasal cavity
Oral cavity

Laryngeal/Pharyngeal Cancer

A throat cancer common among males. The symptoms, which include a sorethroat and loss of voice, are similar to the common cold.

TonguePharynx

LarynxGlottisNose / Throat

Main diseases 1 2 3Main scopes used in TSD

Rhino-Laryngo Scope

Rhino-Laryngo videoscopes are used for looking at the ears, nose, andthroat. Latest videoscopes mount ultra compact, high-performance CCD,
and realize great advances in image quality compared with conventionalmodels. They are also able to perform NBI.

Method of treatment

regarding main diseases 2

Endoscopic Sinus
Surgery (ESS)A minimally invasive treatment for treating sinusitis (empyema) in which chronic
inflammation of the paranasal sinuses (cavities enclosed in bone located near thenasal cavity) causes them to fill with pus and contaminated mucosas. Endoscopic
sinus surgery uses an endoscope to provide a view inside the nose while using adebrider to perform treatment.
Main therapeutic devices used in TSD

Rhino-Laryngo
videoscope

DebriderEndoscope

DebriderESS (image)

A debrider is a surgical device for removing abnormal tissue with simultaneoususe of suction and cutting.

Debrider34