Feasibility of full-thickness gastric resection using master and slave transluminal endoscopic robot and closure by overstitch: a preclinical study
- 877 Downloads
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.
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.
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.
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.
KeywordsEndoscopic full-thickness resection MASTER endoscopic robot Overstitch
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.
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)
- 3.Watanabe K, Ogata S, Kawazoe S, Watanabe K, Koyama T, Kajiwara T, Shimoda Y, Takase Y, Irie K, Mizuguchi M, Tsunada S, Iwakiri R, Fujimoto K (2006) Clinical outcomes of EMR for gastric tumors: historical pilot evaluation between endoscopic submucosal dissection and conventional mucosal resection. Gastrointest Endosc 63:776–782PubMedCrossRefGoogle Scholar
- 9.Phee SJ, Ho KY, Lomanto D, Low SC, Huynh VA, Kencana AP, Yang K, Sun KL, Chung SC (2010) Natural orifice transgastric endoscopic wedge hepatic resection in an experimental model using an intuitively controlled master and slave transluminal endoscopic robot (MASTER). Surg Endosc 24(9):2293–2298PubMedCrossRefGoogle Scholar
- 14.Sakamoto T, Itani T, Okamoto Y, Adachi Y, Hayashi M, Mimura J, Inokuma T (2006) Percutaneous endoscopic gastrostomy by the “direct method” using transnasal endoscopy. Gastroenterol Endosc 48(10):2512–2517Google Scholar