Surgical Endoscopy

, Volume 21, Issue 6, pp 1002–1005 | Cite as

Initial experience with a novel endoscopic device allowing intragastric manipulation and plication

  • John D. MellingerEmail author
  • Bruce V. MacFadyen
  • Richard A. Kozarek
  • Nathaniel D. Soper
  • Desmond H. Birkett
  • Lee L. Swanstrom
Dynamic Manuscipt



Current developments in intraluminal and transluminal natural orifice surgery are limited by issues of access, tissue manipulation, and secure tissue approximation/closure. This report describes an initial laboratory experience with a novel tissue approximation and suturing device. The device is deployed via a previously described platform and is 6 mm in diameter. Desirable qualities of this tissue approximation/closure device include robust tissue grasping, minimal tissue trauma, fully visualized anchor placement via off-axis needle and anchor deployment, full reloadability without instrument withdrawal, single-operator operating capability, torque-stable manipulability, and operator-controlled tension setting of tissue anchor pairs.


The device was trialed in performing several maneuvers in porcine or canine models. The features of the system allowed bimanual tissue manipulation, full-thickness tissue approximation and plication, and secure closure of an ex vivo gastrotomy hole similar to that used during transluminal surgical interventions.


This device appears to offer promise in achieving more complex endoluminal and potentially transluminal tasks, including secure suture closure of tissue defects and access holes. As such, devices of this type may prove useful in addressing some of the identified barriers to further development of natural orifice surgical intervention. Further investigation of the qualities and capabilities of this device in these settings is warranted.


Instruments NOTES Endoluminal Transgastric Transluminal 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

Supplementary material

Supplementary material

Supplementary material

Supplementary material


  1. 1.
    ASGE/SAGES (2005) ASGE/SAGES working group on natural orifice transluminal endoscopic surgery. Gastrointest Endosc 63:199–203Google Scholar
  2. 2.
    Kalloo AN, Singh VK, Jagannath SB, Niiyama H, Hill SL, Vaughn CA, Magee CA, Kantsevoy SV (2004) Flexible transgastric peritoneoscopy: a novel approach to diagnostic and therapeutic interventions. Gastrointest Endosc 60:114–117PubMedCrossRefGoogle Scholar
  3. 3.
    Hochberger J, Lamade W (2005) Transgastric surgery in the abdomen: the dawn of a new era? Gastrointest Endosc 62:293–296PubMedCrossRefGoogle Scholar
  4. 4.
    Jagganath SB, Kantsevoy SV, Faughn CA, Chung SSC, Cotton PB, Gostout CJ, Hawes RH, Pasricha PJ, Scorpio DG, Magee CA, Pipitone LJ, Kalloo AN (2005) Peroral transgastric endoscopic ligation of fallopian tubes with long-term survival in a porcine model. Gastrointest Endosc 61:449–453CrossRefGoogle Scholar
  5. 5.
    Park PO, Bergstrom M, Ikeda K, Fritscher-Ravens A, Swain P (2005) Experimental studies of transgastric gallbladder surgery: cholecystectomy and cholecystogastric anastomosis. Gastrointest Endosc 61:601–606PubMedCrossRefGoogle Scholar
  6. 6.
    Kantsevoy SV, Jagannath SB, Niiyama H, Vaughn CA, Chung SSC, Cotton PB, Gostout CJ, Hawes RH, Pasricha PJ, Magee CA, Barlow D, Shimonaka H, Kalloo AN (2005) Endoscopic gastrojejunostomy with survival in a porcine model. Gastrointest Endosc 62:287–292PubMedCrossRefGoogle Scholar
  7. 7.
    Kantsevoy SV, Hu B, Jagganath SB, Vaughn CA, Beitler DM, Chung SS, Cotton PB, Gostout CJ, Hawes RH, Pasricha PJ, Magee CA, Pipitone LJ, Talamini MA, Kalloo AN (2006) Transgastric endoscopic splenectomy: is it possible? Surg Endosc 20:522–525PubMedCrossRefGoogle Scholar
  8. 8.
    Wagh MS, Merrifield BF, Thompson CC (2005) Endoscopic transgastric abdominal exploration and organ resection: initial experience in a porcine model. Clin Gastroenterol Hepatol 3:892–896PubMedCrossRefGoogle Scholar
  9. 9.
    Wagh MS, Merrifield BF, Thompson CC (2005) Survival studies after endoscopic transgastric oophorectomy and tubectomy in a porcine model: survival studies in a porcine model. Gastrointest Endosc 63:473–478CrossRefGoogle Scholar
  10. 10.
    Merrifield B, Wagh MS, Thompson C (2005) Peroral transgastric organ resection: a feasibility study in pigs. Gastrointest Endosc 63:693–697CrossRefGoogle Scholar
  11. 11.
    Fong DG, Reina DP, Fishman DS, Ryan M, Thompson CC (2006) Transcolonic hepatic wedge resection in a porcine model. Gastrointest Endosc 63:AB102CrossRefGoogle Scholar
  12. 12.
    Swanstrom LL, Kozarek R, Pasricha PJ, Gross S, Birkett D, Park PO, Saadat V, Ewers R, Swain P (2005) Development of a new access device for transgastric surgery. J Gastrointest Surg 9:1129–1137PubMedCrossRefGoogle Scholar
  13. 13.
    Ikeda K, Fritscher-Ravens MD, Mosse CA, Mills T, Tajiri H, Swain P (2005) Endoscopic full-thickness resection with sutured closure in a porcine model. Gastrointest Endosc 62:122–129PubMedCrossRefGoogle Scholar
  14. 14.
    Sclabas GM, Swain P, Swanstrom LL (2006) Endoluminal methods for gastrotomy closure in natural orifice transenteric surgery (NOTES). Surg Innov 13:23–30PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  • John D. Mellinger
    • 1
    Email author
  • Bruce V. MacFadyen
    • 1
  • Richard A. Kozarek
    • 2
  • Nathaniel D. Soper
    • 3
  • Desmond H. Birkett
    • 4
  • Lee L. Swanstrom
    • 5
  1. 1.Department of SurgeryMedical College of GeorgiaAugustaUSA
  2. 2.Department of MedicineVirginia Mason Medical CenterSeattleUSA
  3. 3.Department of SurgeryNorthwestern UniversityEvanstonUSA
  4. 4.Department of General SurgeryLahey Clinic Medical CenterBurlingtonUSA
  5. 5.Department of Minimally Invasive SurgeryLegacy Health SystemPortlandUSA

Personalised recommendations