Abstract
Background
Recently, natural orifice transluminal endoscopic surgery has been introduced using flexible endoscopic technology. Traditional endoscopes lack several capabilities that are needed to perform complex surgical procedures safely. The purpose of this study was to evaluate the new multitasking platform for transgastric small bowel resection including dissection of the mesentery and suturing an anastomosis.
Methods
A new prototype of endoscopic multifunctional platform, EndoSAMURAI™ (ES), was tested. A standardized in vitro setting was established with segments of small bowel and an anastomosis was sutured with the device and compared with that by stapler (ST) and hand-sewn (HS). Leak pressure was measured. In addition, the system was tested in an experimental in vivo situation by performing a transgastric small bowel segmental resection under general anesthesia.
Results
Median time to perform an anastomosis in the bench test was 41 min; median leak pressure for the anastomosis by ES was 14 mmHg, by ST 25 mmHg, and HS 15 mmHg. For the in vivo study, the median total procedure time was 110 min and leak pressure 53 mmHg. These results show that the end-to-end small bowel anastomosis can be sutured sufficiently.
Conclusions
This study has shown that with a multifunctional platform such as the EndoSAMURAI™, the majority of complex surgical tasks can be performed if technically independently moving instruments can be used via an ergonomic workstation interface that allows for laparoscopy-like maneuvers by the operator. Even with the shortcomings of the prototype, it was possible to perform an anastomosis of the small bowel of acceptable quality within a reasonable time.
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References
Kalloo AN, Singh VK, Jagannath SB, Niiyama H, Hill SL, Vaughn CA (2004) Flexible transgastric peritoneoscopy: a novel approach to diagnostic and therapeutic interventions in the peritoneal cavity. Gastrointest Endosc 60:114–117
Kantsevoy SV, Jagannath S, Niiyama H, Scorpio D, Magee CA, Kalloo A (2005) Endoscopic gastrojejunostomy with survival in a porcine model. Gastrointest Endosc 62:287–292
Park PO, Bergström M, Ikeda K, Fritscher-Ravens A, Swain P (2005) Experimental studies of transgastric gallbladder surgery: cholecystectomy and cholecystogastric anastomosis (videos). Gastrointest Endosc 61(4):601–605
Rattner D, Kalloo AN, ASGE/SAGES Working Group (2006) White paper on natural orifice translumenal endoscopic surgery. Surg Endosc 20(2):329–333
Fritscher-Ravens A, Mosse CA, Ikeda K, Swain P (2006) Endoscopic transgastric lymphadenectomy by using EUS for selection and guidance. Gastrointest Endosc 63(2):302–610
Flora ED, Wilson TG, Martin IJ, O`Rourke NA, Maddern GJ (2008) A review of Natural Orifice Translumenal Endoscopic Surgery (NOTES) for intraabdominal surgery. Ann Surg 247(4):583–602
Marescaux J, Dallemagne B, Perretta S, Wattiez A, Mutter D, Coumaros D (2007) Surgery without scars: report of transluminal cholecystectomy in a human being. Arch Surg 142(9):823–826
Fuchs KH, Breithaupt W, Kuhl HJ, Schulz T, Dignass A (2010) Experience with a training program for transgastric procedures in NOTES. Surg Endosc 24:601–609
Fuchs KH, Breithaupt W, Schulz T, Ferencz S, Varga G, Weber G (2011) Transgastric small bowel resection and anastomosis: a survival study. Surg Endosc 24:601–609
Hu B, Chung SC, Kawashima K, Yamamoto T, Cotton PB, Gostout CJ, Hawes RH, Kalloo AN, Kantsevoy SV, Pasricha PJ (2005) Eagle Claw II: a novel endosuture device that uses a curved needle for major arterial bleeding: a bench study. Gastrointest Endosc 62(2):266–270
Magno P, Giday SA, Dray X, Chung SS, Cotton PB, Gostout CJ, Hawes RH, Kalloo AN, Pasricha PJ, White JJ, Assumpcao L, Marohn MR, Gabrielson KL, Kantsevoy SV (2007) A new stapler-based full-thickness transgastric access closure: results from an animal pilot trial. Endoscopy 39:1–5
McGee MF, Marks JM, Jin J, Williams C, Chak A, Schomisch SJ, Andrews J, Okada S, Ponsky JL (2008) Complete endoscopic closure of gastric defects using a full-thickness tissue plicating device. J Gastrointest Surg 12(1):38–45
Meireles OR, Kantsevoy SV, Assumpcao LR, Magno P, Dray X, Giday SA, Kalloo AN, Hanly EJ, Marohn MR (2008) Reliable gastric closure after natural orifice translumenal endoscopic surgery (NOTES) using a novel automated flexible stapling device. Surg Endosc 22:1609–1613
von Renteln D, Schmidt A, Riecken B, Caca K (2008) Gastric full-thickness suturing during EMR and for treatment of gastric-wall defects. Gastrointest Endosc 67(4):738–744
Swanstrom LL, Whiteford M, Kajanchee Y (2008) Developing essential tools to enable transgastric surgery. Surg Endosc 22(3):600–604
Meining A, Kähler G, von Delius S, Buess G, Schneider A, Hochberger J, Wilhelm D, Kübler H, Kranzfelder M, Bajbouj M, Fuchs KH, Gillen S, Feussner H (2009) Natural orifices transluminal endoscopic surgery (NOTES) in Germany: summary of the working group reports of the “D-NOTES meeting 2009”. Z Gastroenterol 47:1–8
Spaun GO, Zheung B, Swanstrom LL (2009) A multitasking platform for natural orifice transluminal endoscopic surgery (NOTES): a benchtop comparison of a new device for flexible endoscopic surgery and a standard dual-channel endoscope. Surg Endosc 23:2720–2727
Disclosures
The senior author (KHF) is a consultant to Olympus Medical Corporation Tokyo. Wolfram Breithaupt has no conflict of interest or financial ties to disclose.
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Fuchs, KH., Breithaupt, W. Transgastric small bowel resection with the new multitasking platform EndoSAMURAI™ for natural orifice transluminal endoscopic surgery. Surg Endosc 26, 2281–2287 (2012). https://doi.org/10.1007/s00464-012-2173-z
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DOI: https://doi.org/10.1007/s00464-012-2173-z