Mucoadhesive film for anchoring assistive surgical instruments in endoscopic surgery: in vivo assessment of deployment and attachment

Abstract

Background

Flexible endoscopic procedures in the gastric cavity are usually performed by operative instruments introduced through the working channels of a gastroscope. To enable additional functions and to widen the spectrum of possible surgical procedures, assistive internal surgical instruments (AISI) may be deployed through the esophagus and fixed onto the gastric wall for the entire duration of the procedure. This paper presents a solution for deploying, positioning, and anchoring AISI inside the stomach by exploiting a chemical approach.

Methods

A mucoadhesive polymer was synthesized and tested inside the stomach. In vivo trials were performed on a porcine model by introducing the AISI provided with mucoadhesive by means of an overtube through the mouth. Targeted deployment was achieved by a purposely developed delivery device, passed through the operative channel of a gastroscope. The total time for deployment, positioning, and anchoring of the AISI was evaluated by testing the procedure with passive modules (10, 12, 15, 20 mm in diameter) and active devices: e.g., a miniaturized wired camera and a wireless illumination module. The time and force required for the detachment of the modules were measured.

Results

The whole procedure of in vivo deployment, positioning, and attachment of an AISI was performed in approximately 6 min. A preload force of 5 N for 3 min was required for anchoring the modules. The stable adhesion was maintained for a maximum of 110 min. Thanks to the positioning of the camera in the fundus, a wide view of the gastric cavity was obtained. The force required to detach the modules reached 2.8 N.

Conclusions

Mucoadhesive anchoring represents a completely biocompatible and safe solution for stable positioning of AISI onto mucosal tissue. This novel polymeric mechanism can be useful for designing intraluminal accessories and tools that enhance surgeons’ performances in endoluminal procedures.

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References

  1. 1.

    Ponsky JL (2006) Endoluminal surgery: past, present and future. Surg Endosc 20:S500–S502

    PubMed  Article  Google Scholar 

  2. 2.

    McCune WS, Shorb PE, Moscovitz H (1968) Endoscopic cannulation of the ampulla of Vater: a preliminary report. Ann Surg 167:752

    PubMed  Article  CAS  Google Scholar 

  3. 3.

    Kawai K, Akasaka Y, Murakami K, Tada M, Koli Y (1974) Endoscopic sphincterotomy of the ampulla of Vater. Gastrointest Endosc 20:148

    PubMed  Article  CAS  Google Scholar 

  4. 4.

    Huibregtse K, Katon RM, Coene PP, Tytgat GN (1986) Endoscopic palliative treatment in pancreatic cancer. Gastrointest Endosc 32:334

    PubMed  Article  CAS  Google Scholar 

  5. 5.

    Lanza FL, Graham DY, Nelson RS, Godines R, McKechnie JC (1981) Endoscopic upper gastrointestinal polypectomy. Am J Gastroenterol 75:345

    PubMed  CAS  Google Scholar 

  6. 6.

    Randall GM (1992) Endoscopic diagnosis of gastric neoplasms. Gastrointest Endosc Clin North Am 2:469

    Google Scholar 

  7. 7.

    Martınez-Serna T, Filipi CJ (1999) Endoluminal surgery. World J Surg 23:368–377

    PubMed  Article  Google Scholar 

  8. 8.

    Cadeddu J, Fernandez R, Desai M, Bergs R, Tracy C, Tang SJ, Rao P, Desai M, Scott D (2009) Novel magnetically guided intra-abdominal camera to facilitate laparoendoscopic single-site surgery: initial human experience. Surg Endosc 23:1894–1899

    PubMed  Article  Google Scholar 

  9. 9.

    Lehman AC, Berg KA, Dumpert J, Wood NA, Visty AQ, Rentschler ME, Platt SR, Farritor SM, Oleynikov D (2008) Surgery with cooperative robots. Comput Aided Surg 13:95–105

    PubMed  Google Scholar 

  10. 10.

    Canes D, Lehman AC, Farritor SM, Oleynikov D, Desai MM (2009) The future of NOTES instrumentation: flexible robotics and in vivo minirobots. J Endourol 23:787–792

    PubMed  Article  Google Scholar 

  11. 11.

    Dominguez G, Durand L, De Rosa J, Danguise E, Arozamena C, Ferraina PA (2009) Retraction and triangulation with neodymium magnetic forceps for single-port laparoscopic cholecystectomy. Surg Endosc 23:1660–1666

    PubMed  Article  Google Scholar 

  12. 12.

    Simi M, Ciuti G, Tognarelli S, Valdastri P, Menciassi A, Dario P (2010) Magnetic link design for a robotic laparoscopic camera. J Appl Phys 107(9):09B302–09B303

    Article  Google Scholar 

  13. 13.

    Harada K, Oetomo D, Susilo E, Menciassi A, Daney D, Merlet JP, Dario P (2010) A reconfigurable modular robotic endoluminal surgical system: vision and preliminary results. Robotica 28(2):171–183

    Article  Google Scholar 

  14. 14.

    Tognarelli S, Pensabene V, Condino S, Valdastri P, Menciassi A, Arezzo A, Dario P (2011) A pilot study on a new anchoring mechanism for surgical applications based on mucoadhesives. Minim Invasiv Ther 20:3–13

    Article  Google Scholar 

  15. 15.

    Dodou D, Breedveld P, Wieringa PA (2006) Stick, unstick, restick sticky films in the colon. Minim Invasiv Ther 15(5):286–295

    Article  Google Scholar 

  16. 16.

    www.givenimaging.com

  17. 17.

    Schulman AP, del Genio F, Sinha N, Rubino F (2009) “Metabolic” surgery for treatment of type 2 diabetes mellitus. Endocr Pract 15(6):624–631

    PubMed  Article  Google Scholar 

  18. 18.

    Blackburn GL, Mun EC (2005) Therapy insight: weight-loss surgery and major cardiovascular risk factor. Nat Clin Pract Cardiovasc Med 2:585–591

    PubMed  Article  Google Scholar 

  19. 19.

    Kobiela J, Stefaniak T, Mackowiak M, Lachinski AJ, Sledzinski Z (2008) NOTES-third generation surgery: vain hopes or the reality of tomorrow? Langenbecks Arch Surg 393:405–411

    PubMed  Article  Google Scholar 

  20. 20.

    Pleskow D, Rothstein R, Haber G, Gostout C, Lo S, Hawes R, Lembo A (2008) Endoscopic full-thickness placation for the treatment of GERD: five-year long-term multicenter results. Surg Endosc 22:326–332

    PubMed  Article  Google Scholar 

  21. 21.

    Kwiatek MA, Pandolfino JE (2008) The Bravo (TM) pH capsule system. Dig Liver Dis 40(3):156–160

    PubMed  Article  CAS  Google Scholar 

  22. 22.

    Schostek S, Müller V, Rieber F, Ho CN, Rakoschi C, Anhoeck G, Schurr MO (2008) Implantable optical sensor concept for the detection of gastrointestinal bleeding. Conference of the society for medical innovation and technology, SMIT 2008

  23. 23.

    Errachid A, Ivorra A, Aguilo J, Villa R, Zine N, Bausells J (2001) New technology for multi-sensor silicon needles for biomedical applications. Sens Actuators B 78:279–284

    Article  Google Scholar 

  24. 24.

    Wang Z, Wang L, Tang B, Frank T, Brown S, Cuschieri A (2008) Retraction by surface ferromagnetisation of target tissues: Preliminary studies on feasibility of magnetic retraction for endoscopic surgery. Surg Endosc 22:1838–1844

    PubMed  Article  Google Scholar 

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Acknowledgment

Research support for this study was provided by the European Commission in the framework of ARAKNES FP7 European Project 224565.

Disclosures

V. Pensabene, P. Valdastri, S. Tognarelli, A. Menciassi, A. Arezzo, and P. Dario have no conflicts of interest or financial ties to disclose.

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Correspondence to P. Valdastri.

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Pensabene, V., Valdastri, P., Tognarelli, S. et al. Mucoadhesive film for anchoring assistive surgical instruments in endoscopic surgery: in vivo assessment of deployment and attachment. Surg Endosc 25, 3071–3079 (2011). https://doi.org/10.1007/s00464-011-1672-7

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Keywords

  • Mucoadhesion
  • Endoluminal surgery
  • Assistive tools
  • Anchoring system