NITI-ON
Surgeon-friendly MIS Instruments

Minimally invasive surgery has influenced the techniques used in every specialty of surgical medicine. Our development has not only led to the replacement of conventional procedures with minimally invasive ones but has also stimulated surgeons to reevaluate conventional approaches with regard to perioperative parameters such as pain medication. In addition, the surgeon extension tools can be applicable to various surgical operations. The Reduced Port Laparoscopic Surgery (RPLS) is a rapidly evolving topic for the laparoscopic surgeons, requiring many new techniques and instruments. By a surgeon who pioneered the single-port approach, it provides novice surgeons with extensive information, examines different surgical techniques, and covers the advantages and pitfalls of RPLS.

Although the single-port laparoscopic surgery has been promoted, it has been difficult to standardize due to instrument interference and difficulty of the technique. In addition, the development of TANKO has been limited due to the stress on the surgeon.

By puncturing a 2mm single-incision from the side of the body and assisting with the developed 2mm BJ instrument, there have been new capabilities to complete the single-port surgery safely and relieve the stress on the surgeon. The work is now on developing a single-port laparoscopic rigid surgical device (all in one) with two flexible forceps that is used through an incision in the patient's navel.

Rigid actuation with force transfer using linkages and gears improves grasper control and tactile feedback of the two shafts and jaws, and Chiba, Japan-based NITI-ON, is leading this research and development.

Established in 1911 by Masataka Honda, a noted manufacturer of surgical and diagnostics instruments for otolaryngologists, NITI-ON has adapted to the changing needs of new devices due to the development of the surgical procedures. The company has been involved in developing surgical instruments that are manufactured using two of the oldest Japanese craftsmen and blacksmith traditions - Kanzashi, a hair ornament made of folded clothes, and Karakuri puppet, a Japanese mechanized doll, or automata. NITI-ON has developed its heat treatment and specific cooling method founded on the principles of making a Japanese sword. The result is the development of highly sophisticated instruments aimed to improve the surgeons’ technical capabilities.

“The surgical instrument division is responsible for the surgeons’ unmet needs and works towards a solution by grappling full use of Quartermaster and Bio design experience at development,” says Hiroshi Honda, CEO NITI-ON.

With the medical devices we have developed, we hope to contribute to Improving value for patients

“Our Quartermaster passed the special biomechanical design skill and processing techniques know-how as part of its commitment to continued growth and to bringing the young generation craftsman, cultivate sensitivity and ensure there is a committed and competent workforce in place to meet future challenges. They design based on the surgeon's posture and skeletal structure during actual practice and understand the current state of reprocessing processes such as cleaning and sterilization, and maintenance methods used in hospitals, leading to the provision of durable product quality.”

Robotic laparoscopic surgery has been proven advantageous for the patient, such as less scarring and better prognosis. In a comparison between surgery by hand and surgery by robot, robotic surgery is sensitive and predominates. However, in order to perform robotic surgery, the surgeon undergoes special training and progress, but the feedback of grasping the tissue is still not transmitted to the surgeons.

In collaboration with the Georgia Institute of Technology, NITI-ON has designed and researched a rigid, single-port device that can be trained by the sensation of hand touch.

The company is developing the linkage and gear mechanisms that are feasible of tactile feedback. Their prototyping experiments reveal that accuracy improves with axial translation compensation. The same movements are transmitted to the tip of the device as those of the hand, and the sensation of grasping the tissue is transmitted to the hand, raising expectations for this assistive technology to make surgical procedures safer and more accurate than ever before.

Fine Grasping and Reduced Incision

The rapidly emerging field of port surgeries promises to revolutionize how the doctors operate, and NITI-ON has been able to develop 2mm instruments that offer fine grasping and enable more accurate small diameter needle control than conventional 5mm forceps. However, the most significant differentiation between the 2mm Instruments and 3mm/5mm diameter instruments is the incision size depending on the instruments’ diameter. There is no need to suture the incision after the surgery, which means high value for the patient. NITI-ON follows the “Add the Needle” concept or Anee concept where the BJ Instrument, which is a reusable 2mm instrument, can be added without hesitation by choosing BJ. On the other hand, when it comes to the tangential field of view, the visibility maximizes its performance.

NITI-ON offers Cobra, an all-purpose electrocautery scalpel which does not obstruct the field of surgeon’s vision due to its narrower (waisted) tip design. The spatula has both a weak and a strong curve (cobra shape) at the tip, which makes it easy to control the direction of dissection by simply rotating the shaft, allowing the approach to dissect past blood vessels and nerves.

Like robotic surgery, the Cobra can be grounded and separated with the tip, and although it is not articulated, its curved tip shape allows it to overcome the limited degrees of freedom.

Final Stage of the New Development

NITI-ON is dedicated to solving future problems and is soon coming up with its new range of products. The company is in the second phase of preclinical research in the development of Double Bendable Forceps with artificial muscle mechanisms.

Honda was a guest at Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) new technology exhibition where he demonstrated NITI-ON’s new concept devices. The exhibition had a host of researchers, and among them, many surgeons and roboticists who showed interest in NITI-ON’s reduced port discussed the operation with the latest materials and mechanisms, and the needs of the world became clear.

Surgeon Technique Modelling and Smart Instruments Project is a unique pneumatic rubber artificial muscle being manufactured. “The grasping force and opening/closing can be felt by air pressure in the handle part that the doctor grasps, and the next-generation instruments that can be handled safely by the function that feeds back the sense of touch is being developed,” says Honda. This project was supported by a grant for an integrated national project, the “Next-Generation Medical Industry Agglomeration Project: Innovative Medical Device Development Demonstration Project”.

With its global footprint further increasing, NITI-ON has had similar opportunities to work with some leading change makers in the medical space. Honda’s team is now involved in manufacturing state-of-the-art instruments.

“We are committed to the design, development and manufacture of innovative and safe medical devices, based on our knowledge and experience of reliable technology, manufacturing and expertise, giving shape to ideas with Japanese manufacturing skills cultivated through experience and achievements,” says Honda. “With the medical devices we have developed, we hope to contribute to Improving value for patients.”

With COVID-19, the world understood what might be in store for the future, but it also showed the human resilience to bow down to any catastrophe. NITI-ON can indeed be the company to rely on for the surgeons.