Top

Published in:

01-02-2014 | Dynamic Manuscript

Feasibility of pure EFTR using an innovative new endoscopic suturing device: the Double-arm-bar Suturing System (with video)

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

Published in: Surgical Endoscopy | Issue 2/2014

Abstract

Background

Endoscopic full-thickness resection (EFTR) requires a reliable full-thickness suturing device and an endoscopic counter-traction device to prevent the collapse of the digestive tract.

Objective

The present study aimed to assess the reliability of newly developed flexible endoscopy suturing devices and the feasibility of pure EFTR.

Methods

A total of 30 EFTRs were performed and allocated to three groups (N = 10 for each group). The full-thickness sutures were placed using over-the-scope clips (OTSCs), hand-sewn sutures, or the Double-arm-bar Suturing System (DBSS). Air leak tests were conducted in the three groups. The times required for the placement of one OTSC suture and single-stitch simple interrupted sutures (hand-sewn and DBSS sutures, respectively) were also compared.

Results

All 30 full-thickness sutures were completely and successfully placed. Regarding the air leak tests, the Mann–Whitney U test showed significant differences between OTSC and hand-sewn sutures (p = 0.003). There was also a significant difference between OTSC and DBSS sutures (p = 0.023). There was no significant difference between hand-sewn and DBSS sutures (p = 0.542). A significant difference was found in the suture time for single-stitch simple interrupted sutures among the OTSC, hand-sewn, and DBSS sutures. The Mann–Whitney U test revealed a significant difference between OTSC and hand-sewn sutures (p = 0.0001). There was no significant difference between OTSC and DBSS sutures (p = 0.533), while a significant difference was found between hand-sewn and DBSS sutures (p = 0.0001).

Conclusions

Pure EFTR is feasible if the mechanical counter traction system is used to expand a small operative field and DBSS is used to make full-thickness sutures. The high safety of full-thickness resection and full-thickness suturing allows for clinical applications of this method.

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 60:114–117PubMedCrossRef

Autorino R, Haber GP, White MA, Khanna R, Altunrende F, Yang B, Forest S, Stein RJ, Kaouk JH (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, Fockens P (2011) Hybrid NOTES transgastric cholecystectomy with reliable gastric closure: an animal survival study. Surg Endosc 25:728–736PubMedCentralPubMedCrossRef

Jeong SH, Lee YJ, Lee EH, Park ST, Choi SK, Hong SC, Jung EJ, Joo YT, Jeong CY, Ha WS (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, Masaki T, Mori T, Sugiyama M, Atomi Y (2009) Endoscopic full-thickness resection with laparoscopic assistance as hybrid NOTES for gastric submucosal tumor. Surg Endosc 23:1908–1913PubMedCrossRef

Kaouk JH, Haber GP, Goel RK, Crouzet S, Brethauer S, Firoozi F, Goldman HB, White WM (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

Isariyawongse JP, McGee MF, Rosen MJ, Cherullo EE, Ponsky LE (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, Kobayashi M, Muramatsu A, Nomura T, Hagiike M, Izuishi K, Suzuki Y, 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.

Dray X, Gabrielson KL, Buscaglia JM, Shin EJ, Giday SA, Surti VC, Assumpcao L, Marohn MR, Magno P, Pipitone LJ, Redding SK, Kalloo AN, Kantsevoy SV (2008) Air and fluid leak tests after NOTES procedures: a pilot study in a live porcine model (with videos). Gastrointest Endosc 68:513–519PubMedCrossRef

11.

Guarner-Argente C, Córdova H, Martínez-Pallí G, Navarro-Ripoll R, Rodríguez-d’Jesús A, de Miguel CR, Beltrán M, Fernández-Esparrach G (2011) Gastrotomy closure with a new tissue anchoring device: a porcine survival study. World J Gastroenterol 17:1732–1738PubMedCentralPubMedCrossRef

12.

Chiu PW, Lau JY, Ng EK, Lam CC, Hui M, To KF, Sung JJ, Chung SS (2008) Closure of a gastrotomy after transgastric tubal ligation by using the Eagle Claw VII: a survival experiment in a porcine model (with video). Gastrointest Endosc 68:554–559PubMedCrossRef

13.

Kantsevoy SV, Thuluvath PJ (2012) Successful closure of a chronic refractory gastrocutaneous fistula with a new endoscopic suturing device (with video). Gastrointest Endosc 75:688–690PubMedCrossRef

14.

Watson RR, Jirapinyo P, Thompson CC (2011) Endoscopic repair of postoperative gastrointestinal fistulae using a novel endoscopic suturing device: technical feasibility and safety. Gastrointest Endosc 73:653CrossRef

15.

von Renteln D, Rudolph HU, Schmidt A, Vassiliou MC, Caca K (2010) Endoscopic closure of duodenal perforations by using an over-the-scope clip: a randomized, controlled porcine study. Gastrointest Endosc 71:131–138CrossRef

16.

von Renteln D, Vassiliou MC, Rothstein RI (2009) Randomized controlled trial comparing endoscopic clips and over-the-scope clips for closure of natural orifice transluminal endoscopic surgery gastrotomies. Endoscopy 41:1056–1061CrossRef

17.

Mori H, Rafiq K, Kobara H, Fujihara S, Nishiyama N, Oryuu M, Suzuki Y, Masaki T (2013) Innovative non-insufflation EFTR: sufficient endoscopic operative field by mechanical counter traction device (with video). Surg Endosc 27(8):3028–3034PubMedCrossRef

18.

Yamamoto H, Kawata H, Sunada K, Sasaki A, Nakazawa K, Miyata T, Sekine Y, Yano T, Satoh K, Ido K, Sugano K (2003) Successful en bloc resection of large superficial tumor in the stomach and colon using sodium hyaluronate and small-caliber-tip transparent hood. Endoscopy 35:690–694PubMedCrossRef

19.

Ono H, Kondo H, Gotoda T, Shirao K, Yamaguchi H, Saito D, Hosokawa K, Shimoda T, Yoshida S (2001) Endoscopic mucosal resection for treatment of early gastric cancer. Gut 48:225–229PubMedCentralPubMedCrossRef

20.

Mori H, Kobara H, Inoue H, Kobayashi M, Muramatsu A, Nomura T, Gong J, Hagiike M, Izuishi K, Suzuki Y, Masaki T (2012) New technique for safer endoscopic submucosal dissection using the duodenal balloon occlusion method. J Gastroenterol Hepatol 27:81–85PubMedCrossRef

21.

Oyama T, Tomori A, Hotta K, Morita S, Kominato K, Tanaka M, Miyata Y (2005) Endoscopic submucosal dissection of early esophageal cancer. Clin Gastroenterol Hepatol 3:S67–S70PubMedCrossRef

22.

Kikuchi T, Fu K, Saito Y, Uraoka T, Fukuzawa M, Fukunaga S, Sakamoto T, Nakajima T, Matsuda T (2010) Transcutaneous monitoring of partial pressure of carbon dioxide during endoscopic submucosal dissection of early colorectal neoplasia with carbon dioxide insufflation: a prospective study. Surg Endosc 24:2231–2235PubMedCrossRef

23.

Schurr MO, Hartmann C, Ho CN, Fleisch C, Kirschniak A (2008) An over-the-scope clip (OTSC) system for closure of iatrogenic colon perforations: results of an experimental survival study in pigs. Endoscopy 40:584–588PubMedCrossRef

24.

Kirschniak A, Subotova N, Zieker D, Königsrainer A, Kratt T (2011) The Over-The-Scope Clip (OTSC) for the treatment of gastrointestinal bleeding, perforations, and fistulas. Surg Endosc 25:2901–2905PubMedCrossRef

25.

26.

Parodi A, Repici A, Pedroni A, Blanchi S, Conio M (2010) Endoscopic management of GI perforations with a new over-the-scope clip device (with videos). Gastrointest Endosc 72:881–886PubMedCrossRef

27.

Title: Feasibility of pure EFTR using an innovative new endoscopic suturing device: the Double-arm-bar Suturing System (with video)
Authors: Hirohito Mori
Hideki Kobara
Shintaro Fujihara
Noriko Nishiyama
Kazi Rafiq
Makoto Oryu
Masao Fujiwara
Yasuyuki Suzuki
Tsutomu Masaki
Publication date: 01-02-2014
Publisher: Springer US
Published in: Surgical Endoscopy / Issue 2/2014
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-013-3266-z

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Feasibility of pure EFTR using an innovative new endoscopic suturing device: the Double-arm-bar Suturing System (with video)

Abstract

Background

Objective

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Objective

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 2/2014

Clinical validity of the expanded criteria for endoscopic resection of undifferentiated-type early gastric cancer based on long-term outcomes

The prevalence of laparoscopy and patient safety outcomes: an analysis of colorectal resections

Transvaginal organ extraction: potential for broad clinical application

Erratum to: Preoperative opioid use and the outcome of thoracoscopic splanchnicectomy in chronic pancreatitis: a systematic review

Submucosal tunneling endoscopic resection for small upper gastrointestinal subepithelial tumors originating from the muscularis propria layer

Symptom analysis improves GERD diagnosis and may be helpful to define a successful surgical approach