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Novel device to detect enterotomies in real time during laparoscopy: first in human trial during Roux-en-y gastric bypass

Abstract

Background

Undetected bowel perforations occur in 0.3–1% of laparoscopic surgical procedures with an associated mortality rate of 5.3%.

Objective

The purpose of the study was to evaluate the clinical feasibility of a novel medical device to accurately detect bowel gas, specifically hydrogen (H2) and methane (CH4), from a sample of gas from the abdominal cavity during laparoscopic surgery when a known bowel wall perforation has occurred. Setting: University (Academic) Hospital.

Methods

A prospective single arm study was composed of 8 patients undergoing a standard laparoscopic roux-en-y gastric bypass. At seven time points during the operation intra-abdominal gas was pulled from the abdominal cavity and analyzed using the novel device for H2 and CH4. The time points included after insufflation (T1), after first jejunotomy (T2), after closure of jejunotomy (T3), after recycle of carbon dioxide gas (T4), after gastrostomy (T5), after jejunotomy (T6), at procedure end (T7).

Results

Eight patients were enrolled in the study; in 7 (87.5%) patients data from all 7 time points were obtained. After the first opening of the small bowel (T2) mean hydrogen levels were significantly increased compared to baseline hydrogen levels (T1, T4, T7) (p < 0.001). At all time points, there was no significant detection of methane. There were no intra-operative or post-operative complications during the study.

Conclusion

Hydrogen gas is released into the intra-abdominal cavity when bowel is opened and can be detected in real time using a novel device during laparoscopic surgery. The presence or absence of hydrogen directly correlates to whether the bowel is open (perforated) or intact. This device could be used in the future to detect unintended bowel perforations during laparoscopic surgery, prior to the conclusion of the operation. This technology could also potentially lead to novel mechanism for detecting postoperative leaks using gas detection technology.

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References

  1. Al-Qurayshi Z, Srivastav S, Slakey DP, Kandil E (2016) Risk of intraoperative injury of nearby structures: national trend, distribution, and burden. J Am Coll Surg 222:624–631

    Article  PubMed  Google Scholar 

  2. van der Voort M, Heijnsdijk EA, Gouma DJ (2004) Bowel injury as a complication of laparoscopy. Br J Surg 91:1253–1258

    Article  PubMed  Google Scholar 

  3. Schwartz MJ, Faiena I, Cinman N, Kucharczyk J, Meriggi JS, Waingankar N, Richstone L, Kavoussi LR (2010) Laparoscopic bowel injury in retroperitoneal surgery: current incidence and outcomes. J Urol 184:589–594

    Article  PubMed  Google Scholar 

  4. Dindo D, Schafer M, Muller MK, Clavien P-A, Hahnloser D (2010) Laparoscopy for small bowel obstruction: the reason for conversion matters. Surg Endosc 24:792–797

    Article  CAS  PubMed  Google Scholar 

  5. Wullstein C, Gross E (2003) Laparoscopic compared with conventional treatment of acute adhesive small bowel obstruction. Br J Surg 90:1147–1151

    Article  CAS  PubMed  Google Scholar 

  6. Suter M, Zermatten P, Halkic N, Martinet O, Bettschart V (2000) Laparoscopic management of mechanical small bowel obstruction. Surg Endosc 14:478–483

    Article  CAS  PubMed  Google Scholar 

  7. Llarena NC, Shah AB, Milad MP (2015) Bowel injury in gynecologic laparoscopy: a systematic review. Obstet Gynecol 125:1407–1417

    Article  PubMed  Google Scholar 

  8. Galleano R, Franceschi A, Ciciliot M, Falchero F, Cuschieri A (2011) Errors in laparoscopic surgery: what surgeons should know. Minerva Chir 66:107–117

    CAS  PubMed  Google Scholar 

  9. Deffieux X, Ballester M, Collinet P, Fauconnier A, Pierre F, Obstetricians FNCoGa (2011) Risks associated with laparoscopic entry: guidelines for clinical practice from the French College of Gynaecologists and Obstetricians. Eur J Obstet Gynecol Reprod Biol 158:159–166

    Article  PubMed  Google Scholar 

  10. Singh JP, Steward MJ, Booth TC, Mukhtar H, Murray D (2010) Evolution of imaging for abdominal perforation. Ann R Coll Surg Engl 92:182–188

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Feldman M, Friedman L, Brandt L (2015) Fordtran’s Gastrointestinal and liver disease—pathophysiology, diagnosis, management, 10th edn, Saunders

  12. Sharma M, Makharia G (2000) Intestinal gas—its syndromes. JK Science 2:75–80

    Google Scholar 

  13. Sahakian AB, Jee SR, Pimentel M (2010) Methane and the gastrointestinal tract. Dig Dis Sci 55:2135–2143

    Article  PubMed  Google Scholar 

  14. Sosna J, Bar-Ziv J, Libson E, Eligulashvili M, Blachar A (2008) CT colonography: positioning order and intracolonic pressure. AJR Am J Roentgenol 191:1100

    Article  PubMed  Google Scholar 

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Funding

The company made the device available at no cost and provided support for its use. No funding was received for this trial.

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Correspondence to Dan E. Azagury.

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Dr. Elisabeth Wynne and Dr. Dan Azagury have no conflicts of interest or financial ties to disclose.

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Wynne, E.K., Azagury, D.E. Novel device to detect enterotomies in real time during laparoscopy: first in human trial during Roux-en-y gastric bypass. Surg Endosc 33, 1687–1692 (2019). https://doi.org/10.1007/s00464-018-06637-2

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  • DOI: https://doi.org/10.1007/s00464-018-06637-2

Keywords

  • Laparoscopy
  • Bowel injury
  • Bariatric
  • Bowel perforation
  • Bowel gas
  • Injury