Top

Published in:

01-08-2013 | Dynamic Manuscript

Innovative noninsufflation EFTR: sufficient endoscopic operative field by mechanical counter traction device

Authors: Hirohito Mori, Kazi Rafiq, Hideki Kobara, Shintaro Fujihara, Noriko Nishiyama, Makoto Oryuu, Yasuyuki Suzuki, Tsutomu Masaki

Published in: Surgical Endoscopy | Issue 8/2013

Abstract

Background

No reliable pure natural orifice transluminal endoscopic surgery (NOTES) mechanical counter traction (MCT) device for the flexible endoscope to obtain a sufficient surgical endoscopic field has yet been developed. Our experience with 10 cases of hybrid NOTES prompted the realization of the importance of an MCT device for the flexible endoscope and inspired us to establish innovative noninsufflation endoscopic full-thickness resection (EFTR) with an MCT device.

Methods

We performed 40 EFTR 40 mm in diameter on excised whole porcine stomachs. Twenty were resected by an MCT device to obtain a surgical field (MCT group), and another 20 were resected with a conventional endoscopic attachment (control group). We evaluated the successful resection rates of EFTR and procedure times between two groups. Next, we implemented EFTR with a custom prototype MCT device in three cases of stomach pseudotumors in female dogs. Gastric pseudotumors ~40 mm in diameter were marked within the open surgical field created by the MCT device. After resecting the pseudotumors, we conducted full-thickness suturing using over-the-scope clips.

Results

In the MCT group, all 20 cases were completely resected. On the other hand, in the control group, only 8 cases were performed via EFTR (P < 0.01). The mean ± standard deviation EFTR procedure times for the MCT and control groups were 4.13 ± 0.824 and 36.26 ± 8.67 min, respectively (P = 0.001). In three dogs, sufficient surgical working spaces were obtained up to 78 mm (range, 65–78 mm), and full-thickness resections were performed safely and sutured with over-the-scope clips.

Conclusions

Our new prototype MCT device effectively obtains a sufficient surgical endoscopic field during EFTR. We are developing a new MCT with a bending function to perform EFTR in any location in the stomach.

Available only for authorised users

Kalloo AN, Singh VK, Jagannath SB, Niiyama H, Hill SL, Vaughn CA, Magee CA, Kantsevoy SV (2004) Flexible transgastric peritoneoscopy: a novel approach to diagnostic and therapeutic interventions in the peritoneal cavity. Gastrointest Endosc 60(1):114–117PubMedCrossRef

Autorino R, Haber GP, White MA (2010) Pure and hybrid natural orifice transluminal endoscopic surgery (NOTES): current clinical experience in urology. BJU Int 106:919–922PubMedCrossRef

Voermans RP, van Berge Henegouwen MI, Bemelman WA (2011) Hybrid NOTES transgastric cholecystectomy with reliable gastric closure: an animal survival study. Surg Endosc 25:728–736PubMedCrossRef

Kaouk JH, Haber GP, Goel RK (2010) Pure natural orifice translumenal endoscopic surgery (NOTES) transvaginal nephrectomy. Eur Urol 57:723–726PubMedCrossRef

Isayama H, Kogure H, Koike K (2011) Endoscopic transgastric pure NOTES cholecystectomy with naso-gallbladder drainage tube placement and injection of a hyaluronic acid mixture (with video). J Hepatobiliary Pancreat Sci 18:106–111PubMedCrossRef

Jeong SH, Lee YJ, Lee EH (2010) Gastric lymphatic basin dissection for sentinel node biopsy using hybrid natural orifice transluminal endoscopic surgery (NOTES). Minim Invasive Ther Allied Technol 19:299–303PubMedCrossRef

Abe N, Takeuchi H, Yanagida O (2009) Endoscopic full-thickness resection with laparoscopic assistance as hybrid NOTES for gastric submucosal tumor. Surg Endosc 23:1908–1913PubMedCrossRef

Isariyawongse JP, McGee MF, Rosen MJ (2008) Pure natural orifice transluminal endoscopic surgery (NOTES) nephrectomy using standard laparoscopic instruments in the porcine model. J Endourol 22:1087–1091PubMedCrossRef

Mori H, Kobara H, Masaki T (2011) Establishment of pure NOTES procedure using a conventional flexible endoscope: review of six cases of gastric gastrointestinal stromal tumors. Endoscopy 43:631–634PubMedCrossRef

10.

Mori H, Kobara H, Masaki T (2012) New technique for safer endoscopic submucosal dissection using the duodenal balloon occlusion method. J Gastroenterol Hepatol 27:81–85PubMedCrossRef

11.

Nijhawan S, Barajas-Gamboa JS, Majid S, Jacobsen GR, Sedrak MF, Sandler BJ, Talamini MA, Horgan S (2012) NOTES transvaginal hybrid cholecystectomy: the United States human experience. Surg Endosc (Epub ahead of print). doi:10.1007/s00464-012-2470-6

12.

Shinoda M, Makino A, Wada M (2010) Successful endoscopic submucosal dissection for mucosal cancer of the duodenum. Dig Endosc 22:49–52PubMedCrossRef

13.

Honda T, Yamamoto H, Osawa H (2009) Endoscopic submucosal dissection for superficial duodenal neoplasms. Dig Endosc 21:270–274PubMedCrossRef

14.

Takahashi T, Ando T, Kabeshima Y (2009) Borderline cases between benignancy and malignancy of the duodenum diagnosed successfully by endoscopic submucosal dissection. Scand J Gastroenterol 44:1377–1383PubMedCrossRef

15.

Bernhardt J, Köhler P, Rieber F (2012) Pure NOTES sigmoid resection in an animal survival model. Endoscopy 44:265–269PubMedCrossRef

16.

Hagen ME, Wagner OJ, Swain P (2008) Hybrid natural orifice transluminal endoscopic surgery (NOTES) for Roux-en-Y gastric bypass: an experimental surgical study in human cadavers. Endoscopy 40:918–924PubMedCrossRef

17.

Madan AK, Tichansky DS, Khan KA (2008) Natural orifice transluminal endoscopic gastric bypass performed in a cadaver. Obes Surg 18:1192–1199PubMedCrossRef

18.

Nau P, Anderson J, Happel L (2011) Safe alternative transgastric peritoneal access in humans: NOTES. Surgery 149:147–152PubMedCrossRef

19.

Ikeda K, Sumiyama K, Tajiri H (2011) Evaluation of a new multitasking platform for endoscopic full-thickness resection. Gastrointest Endosc 73:117–122PubMedCrossRef

20.

Dray X, Giday SA, Buscaglia JM (2009) Omentoplasty for gastrotomy closure after natural orifice transluminal endoscopic surgery procedures (with video). Gastrointest Endosc 70:131–140PubMedCrossRef

Title: Innovative noninsufflation EFTR: sufficient endoscopic operative field by mechanical counter traction device
Authors: Hirohito Mori
Kazi Rafiq
Hideki Kobara
Shintaro Fujihara
Noriko Nishiyama
Makoto Oryuu
Yasuyuki Suzuki
Tsutomu Masaki
Publication date: 01-08-2013
Publisher: Springer US
Published in: Surgical Endoscopy / Issue 8/2013
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-013-2846-2

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Innovative noninsufflation EFTR: sufficient endoscopic operative field by mechanical counter traction device

Abstract

Background

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 8/2013

Expert pathology review and endoscopic mucosal resection alters the diagnosis of patients referred to undergo therapy for Barrett’s esophagus

Pure transvesical NOTES appendectomy using a 5-mm rigid laparoscope: a feasibility and survival study with porcine models

Techniques for laparoscopic repair of major intraoperative vascular injury: case reports and review of literature

Effective and efficient learning in the operating theater with intraoperative video-enhanced surgical procedure training

Transanal endoscopic microsurgery after neoadjuvant radiochemotherapy for locally advanced extraperitoneal rectal cancer: short-term morbidity and functional outcome

Prognosis of incidental gallbladder carcinoma is not influenced by the primary access technique: analysis of 837 incidental gallbladder carcinomas in the German Registry