Reliable gastric closure after natural orifice translumenal endoscopic surgery (NOTES) using a novel automated flexible stapling device

O. R. Meireles; S. V. Kantsevoy; L. R. Assumpcao; P. Magno; X. Dray; S. A. Giday; A. N. Kalloo; E. J. Hanly; M. R. Marohn

doi:10.1007/s00464-008-9750-1

Reliable gastric closure after natural orifice translumenal endoscopic surgery (NOTES) using a novel automated flexible stapling device

O. R. Meireles, S. V. Kantsevoy, L. R. Assumpcao, P. Magno, X. Dray, S. A. Giday, A. N. Kalloo, E. J. Hanly, M. R. Marohn

School of Medicine

Research output: Contribution to journal › Article › peer-review

49 Scopus citations

Abstract

Background: Reliable closure of the translumenal incision is one of the main challenges facing natural orifice translumenal endoscopic surgery (NOTES). This study aimed to evaluate the use of an automated flexible stapling device (SurgASSIST) for closure of the gastrotomy incision in a porcine model. Methods: A double-channel gastroscope was advanced into the stomach. A gastric wall incision was made, and the endoscope was advanced into the peritoneal cavity. After peritoneoscopy, the endoscope was withdrawn into the stomach. The SurgASSIST stapler was advanced orally into the stomach. The gastrotomy edges were positioned between the opened stapler arms using two endoscopic grasping forceps. Stapler loads with and without a cutting blade were used for gastric closure. After firing of the stapler to close the gastric wall incision, x-ray with contrast was performed to assess for gastric leakage. At the end of the procedure, the animals were killed for a study of closure adequacy. Results: Four acute animal experiments were performed. The delivery and positioning of the stapler were achieved, with technical difficulties mostly due to a short working length (60 cm) of the device. Firing of the staple delivered four rows of staples. Postmortem examination of pig 1 (when a cutting blade was used) demonstrated full-thickness closure of the gastric wall incision, but the cutting blade caused a transmural hole right at the end of the staple line. For this reason, we stopped using stapler loads with a cutting blade. In the three remaining animals (pigs 2-4), we were able to achieve a full-thickness closure of the gastric wall incision without any complications. Conclusions: The flexible stapling device may provide a simple and reliable technique for lumenal closure after NOTES procedures. Further survival studies are currently under way to evaluate the long-term efficacy of gastric closure with the stapler after intraperitoneal interventions.

Original language	English (US)
Pages (from-to)	1609-1613
Number of pages	5
Journal	Surgical Endoscopy and Other Interventional Techniques
Volume	22
Issue number	7
DOIs	https://doi.org/10.1007/s00464-008-9750-1
State	Published - Jul 1 2008

Keywords

Flexible endoscopy
Gastric closure
NOTES
Transgastric
Translumenal procedures

ASJC Scopus subject areas

Surgery

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10.1007/s00464-008-9750-1

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Meireles, O. R., Kantsevoy, S. V., Assumpcao, L. R., Magno, P., Dray, X., Giday, S. A., Kalloo, A. N., Hanly, E. J., & Marohn, M. R. (2008). Reliable gastric closure after natural orifice translumenal endoscopic surgery (NOTES) using a novel automated flexible stapling device. Surgical Endoscopy and Other Interventional Techniques, 22(7), 1609-1613. https://doi.org/10.1007/s00464-008-9750-1

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', Surgical Endoscopy and Other Interventional Techniques, vol. 22, no. 7, pp. 1609-1613. https://doi.org/10.1007/s00464-008-9750-1

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abstract = "Background: Reliable closure of the translumenal incision is one of the main challenges facing natural orifice translumenal endoscopic surgery (NOTES). This study aimed to evaluate the use of an automated flexible stapling device (SurgASSIST) for closure of the gastrotomy incision in a porcine model. Methods: A double-channel gastroscope was advanced into the stomach. A gastric wall incision was made, and the endoscope was advanced into the peritoneal cavity. After peritoneoscopy, the endoscope was withdrawn into the stomach. The SurgASSIST stapler was advanced orally into the stomach. The gastrotomy edges were positioned between the opened stapler arms using two endoscopic grasping forceps. Stapler loads with and without a cutting blade were used for gastric closure. After firing of the stapler to close the gastric wall incision, x-ray with contrast was performed to assess for gastric leakage. At the end of the procedure, the animals were killed for a study of closure adequacy. Results: Four acute animal experiments were performed. The delivery and positioning of the stapler were achieved, with technical difficulties mostly due to a short working length (60 cm) of the device. Firing of the staple delivered four rows of staples. Postmortem examination of pig 1 (when a cutting blade was used) demonstrated full-thickness closure of the gastric wall incision, but the cutting blade caused a transmural hole right at the end of the staple line. For this reason, we stopped using stapler loads with a cutting blade. In the three remaining animals (pigs 2-4), we were able to achieve a full-thickness closure of the gastric wall incision without any complications. Conclusions: The flexible stapling device may provide a simple and reliable technique for lumenal closure after NOTES procedures. Further survival studies are currently under way to evaluate the long-term efficacy of gastric closure with the stapler after intraperitoneal interventions.",

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AU - Magno, P.

AU - Dray, X.

AU - Giday, S. A.

AU - Kalloo, A. N.

AU - Hanly, E. J.

AU - Marohn, M. R.

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Reliable gastric closure after natural orifice translumenal endoscopic surgery (NOTES) using a novel automated flexible stapling device

Abstract

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