Message from Symposium Chair － ISFES2018

It is our great pleasure to hold the 1st International Symposium of Flexible Endoscopic Surgery in Tokyo on January 26, 2018. The aim of this symposium is to share the latest expertise and experiences on flexible endoscopic surgery in order to address its challenges and potentials as technologies and devices advance, and to encourage academic, clinical and research achievement in the surgery both domestically and globally.

In the area of surgery, the use of minimally invasive techniques has become increasingly common and refined, and even many highly advanced procedures that could have previously been performed only by an open approach have proved to be feasible laparoscopically. Such advancement has been closely linked with the progress of minimally invasive surgical instruments. A revolutionary surgical device, a robot-assisted rigid endoscopic surgical system was launched in the US in 2001, and its use has been widened to more complicated procedures, enhancing precision by giving surgeons' hands higher dexterity. With regards to procedures using endoscopic devices, novel minimally invasive treatments including Endoscopic Submucosal Dissection (ESD) and Per-oral Endoscopic Myotomy (POEM) have been developed in succession, attracting high attention. However, there are still regions deeper in the body that are difficult to access and treat with rigid instruments, even robotic ones, and at the same time, manipulating the forceps for endoscopic procedures requires extremely high skills. In order to overcome these challenges, a number of research and development projects for MIS instruments are being conducted all over the world.

Looking back on the history of endoscopy, the first practical endoscope was developed and has evolved in Japan. Japan has constantly been on the global leading edge in the field of flexible endoscopy technology and procedures. With Japan's unique strengths and support from the Japan Agency for Medical Research and Development (AMED), we have organized an industry-academia consortium and started the R&D project for an innovative concept of flexible endoscopic surgery system named FESS©.

Wishing for further development of flexible endoscopic surgery, we have organized this symposium in order to provide an opportunity for physicians and researchers to share the comprehensive and most advanced knowledge on current flexible endoscopic surgery and to actively exchange ideas with the world’s most distinguished experts in this field. As guest speakers from overseas, we have invited Professor David Rattner from Harvard Medical School, Boston and Dr. Amir Szold from Tel Aviv, Israel. At the pre-symposium seminar on the previous day, January 25, Professor Phillip Chiu from Hong Kong will give us a special lecture, followed by a reception for participants to get together in a relaxed and friendly environment. This will be the initial step of our plan to continuously provide this platform with an ever-wider range of participants, responding to the future development of flexible endoscopic surgery. We will do our very best to make the symposium a highly productive and informative experience for all who attend, and a worthy inaugural event for future international symposia on flexible endoscopic surgery.

I sincerely thank you for your continued support and look forward to welcoming you at the symposium in Tokyo.

Yuko Kitagawa, MD, PhD, FACS
Symposium Chair
The 1st International Symposium of Flexible Endoscopic Surgery
Department of Surgery, Keio University School of Medicine

　このたび軟性内視鏡手術にフォーカスした研究会をたちあげ、2018年1月26日に第1回国際シンポジウムを開催することとなりました。本シンポジウムは、軟性内視鏡手術に関する最新の知見と実際の経験を共有することで、軟性内視鏡手術の課題と可能性を明らかにし、日本国内、世界に向けて、今後の進歩、普及に役立てることを目的としています。
　ご承知のとおり、外科領域において低侵襲化の流れは進化を続け、従来開腹手術でしか行えなかった高度な手技が腹腔鏡下に実施できるようになってきました。このような流れは低侵襲医療機器の進歩と不可分にあります。米国で2000年に登場した手術ロボットにより、低侵襲かつ高精度な操作が可能となりました。一方、内視鏡手術の分野ではESD（内視鏡的粘膜下層剥離術）やPOEM（経口内視鏡的筋層切開術）など、新たな低侵襲治療が相次いで開発され注目されています。現状では、直線的にアプローチしづらい身体の深部では、手術ロボットには操作が難しいという問題があります。また、内視鏡手術は鉗子の操作に極めて高度な技量を要し、日本国外での普及は限られているのが実情です。これらの課題を克服する低侵襲医療機器開発の取り組みが世界各国で行われています。もとより内視鏡はわが国で開発・発展してきた歴史があり、軟性内視鏡の分野では国際的にも日本がリードしてきました。我々も、日本医療政策開発機構（AMED）の支援のもと、産学プロジェクトチームにて日本の叡智を結集し、新しいコンセプトの軟性内視鏡手術システムの開発に取り組んでおります。
　上記を背景とし、軟性内視鏡手術の現状について包括的で最先端の知識を共有し、活発な討論を行う場を提供することを目的に本研究集会を企画いたしました。軟性内視鏡手術に実績のある内外のエキスパートを中心に、この分野に経験や関心を持つ臨床医やコメディカルが集まり、軟性内視鏡手術の克服すべき課題と可能性を明らかにし、今後の進歩、普及に役立てることを目指します。海外からHarvardのD. Rattner先生とイスラエルのA. Szold先生をお招きしています。前日の1月25日にはプレシンポジウムとしてP. Chiu先生のレクチャーと懇親の場を用意しております。
　今回を第一ステップとし、今後さらに多数の先生方にご参加を賜りまして、発展充実させて参りたいと思っております。第１回として相応しい、実り多い研究集会となりますように最善を尽くす所存でございますのでご支援ご指導のほどよろしくお願い申し上げます。多くの皆様のご参加をお待ちしております。