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Surgical Endoscopy

, Volume 28, Issue 1, pp 319–324 | Cite as

Feasibility of full-thickness gastric resection using master and slave transluminal endoscopic robot and closure by overstitch: a preclinical study

  • Philip W. Y. Chiu
  • S. J. Phee
  • Z. Wang
  • Z. Sun
  • Carmen C. Poon
  • T. Yamamoto
  • I. Penny
  • Jennie Y. Y. Wong
  • James Y. W. Lau
  • K. Y. Ho
Dynamic Manuscript

Abstract

Background

Gastric submucosal tumors are often treated by laparoscopic wedge resection. This study aimed to examine the feasibility of gastric full-thickness resection through a totally endoscopic approach using the master and slave transluminal endoscopic robot (MASTER), and closure of the luminal defect with an endoscopic suturing device.

Methods

The operation was performed in two live porcine models under general anesthesia. First, the anterior wall of the stomach was slung to the abdominal wall using a percutaneous suturing device. An imaginary 5-cm lesion was marked using a needle knife. After the initial mucosal incision was made using an IT knife, the MASTER was introduced through a long overtube. A circumferential mucosal incision was completed with the MASTER to expose the muscularis propria which was grasped and incised to the serosal layer by electrocautery applied through the hook of the MASTER. The full-thickness resection of the gastric wall was completed with retraction using the grasper and dissection using the hook. While the defect was being created, the luminal space was maintained with traction of the percutaneous sutures. The defect was closed with suture plication using an Apollo Overstitch device.

Results

Two full-thickness gastric resections were performed in two nonsurvival porcine models (body weight = 30 and 35 kg, respectively) using the MASTER. The total procedure time was 56 min for the first model and 70 min for the second model. The luminal view was maintained during the whole procedure, and there was no damage to surrounding organs throughout the whole procedure. The gastric defects were closed successfully using Overstitch, with satisfactory gastric distension and no gas leakage afterward.

Conclusion

The current experiment demonstrated the feasibility and safety of a totally endoscopic approach for the treatment of gastric submucosal tumors: full-thickness resection with the MASTER and successful closure of the defect using Overstitch.

Keywords

Endoscopic full-thickness resection MASTER endoscopic robot Overstitch 

Notes

Disclosures

P. W. Y. Chiu served on the scientific advisory board of EndoMaster Ple Ltd. S. J. Phee and K. Y. Ho are cofounders of EndoMaster Ple Ltd.

Supplementary material

Electronic supplementary material The online version of this article (doi:  10.1007/s00464-013-3149-3) contains supplementary material which is available to authorized users. Abstract selected for oral presentation at the 2013 annual meeting of the Society of American Gastrointestinal and Endoscopic Surgeons, Baltimore, MD, 17–20 April 2013. (AVI 25208 kb)

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Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Philip W. Y. Chiu
    • 1
  • S. J. Phee
    • 2
  • Z. Wang
    • 2
  • Z. Sun
    • 2
  • Carmen C. Poon
    • 1
  • T. Yamamoto
    • 2
  • I. Penny
    • 2
  • Jennie Y. Y. Wong
    • 3
  • James Y. W. Lau
    • 1
  • K. Y. Ho
    • 3
  1. 1.Department of Surgery, Institute of Digestive Disease, CUHK Jockey Club Minimally Invasive Surgical Skills CenterThe Chinese University of Hong KongHong Kong S.A.RChina
  2. 2.School of Mechanical and Aerospace EngineeringNanyang Technological UniversitySingaporeSingapore
  3. 3.Department of Medicine Yong Loo Lin School of MedicineNational University of SingaporeSingaporeSingapore

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