Gastric slow waves regulate peristalsis, and gastric dysrhythmias have been implicated in functional motility disorders. To accurately define slow wave patterns, it is currently necessary to collect high-resolution serosal recordings during open surgery. We therefore developed a novel gastric slow wave mapping device for use during laparoscopic procedures.
The device consists of a retractable catheter constructed of a flexible nitinol core coated with Pebax. Once deployed through a 5-mm laparoscopic port, the spiral head is revealed with 32 electrodes at 5 mm intervals. Recordings were validated against a reference electrode array in pigs and tested in a human patient.
Recordings from the device and a reference array in pigs were identical in frequency (2.6 cycles per minute; p = 0.91), and activation patterns and velocities were consistent (8.9 ± 0.2 vs 8.7 ± 0.1 mm s−1; p = 0.2). Device and reference amplitudes were comparable (1.3 ± 0.1 vs 1.4 ± 0.1 mV; p = 0.4), though the device signal-to-noise ratio was higher (17.5 ± 0.6 vs 12.8 ± 0.6 dB; P < 0.0001). In the human patient, corpus slow waves were recorded and mapped (frequency 2.7 ± 0.03 cycles per minute, amplitude 0.8 ± 0.4 mV, velocity 2.3 ± 0.9 mm s−1).
In conclusion, the novel laparoscopic device achieves high-quality serosal slow wave recordings. It can be used for laparoscopic diagnostic studies to document slow wave patterns in patients with gastric motility disorders.
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The authors gratefully acknowledge the assistance of Tim Angeli, Ryash Vather, Linley Nisbet, Grant Beban and the surgical staff at Auckland City Hospital with data collection.
This work was supported in part by grants from the International Foundation for Functional Gastrointestinal Disorders (IFFGD), Maurice and Phyllis Paykel Trust (MPPT), Health Research Council of New Zealand, NIH (R01 DK64775), and Medical Technologies Centre of Research Excellence (MedTech CoRE), New Zealand. RB was supported by a Commonwealth Scholarship, PD by the Marsden Fund and LC by a Fraunhofer-Bessel Research Award from the Alexander von Humboldt Foundation and the Fraunhofer IPA.
Niranchan Paskaranandavadivel, Peng Du, Gregory O’Grady and Leo K. Cheng hold intellectual property and/or patent applications in the field of mapping gastrointestinal electrophysiology. Rachel Berry, Mark L. Trew and John A. Windsor report no conflict of interest or financial ties to disclose.
Ethical approval for pig experiments was obtained from the University of Auckland Animal Ethics Committee. Human studies were approved by the Northern Y Health and Disability Ethics Committee. The patient provided informed consent prior to participating.
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Berry, R., Paskaranandavadivel, N., Du, P. et al. A novel retractable laparoscopic device for mapping gastrointestinal slow wave propagation patterns. Surg Endosc 31, 477–486 (2017). https://doi.org/10.1007/s00464-016-4936-4
- Gastric electrical activity
- Gastric dysrhythmia
- High-resolution mapping