Skip to main content
Top
Published in: Surgical Endoscopy 6/2020

Open Access 01-06-2020 | New Technology

MIEO: a micro-invasive endoscopic operation port system for transluminal interventions—an acute and survival porcine study

Authors: D. Wilhelm, T. Vogel, A. Jell, S. Brunner, M. Kranzfelder, N. Wantia, H. Feussner, D. Ostler, S. Koller

Published in: Surgical Endoscopy | Issue 6/2020

Login to get access

Abstract

Background

A reliable and sterile access through the intestinal wall to ease flexible endoscopic transluminal interventions is still appealing but lacks a suitable port system.

Methods

In a granted industry cooperation, we developed the MIEO-Port, a flexible three components overtube system that provides a temporary hermetic sealing of the intestinal wall to allow endoscopic disinfection and manipulation to gain access to the abdominal cavity. The port features an innovative head part which allows for coupling the port to the intestinal wall by vacuum suction and for controlled jetting the isolated intestinal surface with a disinfectant. The device was tested in vivo in 6 pigs for acute and long-term usability. All animal tests were approved by the local ethics committee.

Results

In the acute experiment, the port system supported sealed endoscopic mucosa resection and transluminal cholecystectomy. In the survival study on 5 animals, the MIEO-Port proved its reliability after transcolonic peritoneoscopy. In one animal, a port dislocation occurred after extensive retroperitoneal preparation, one animal revealed bacterial contamination at necropsy; however, all animals showed a favourable course over ten days and offered no signs of peritonitis or abscedation during post-mortem examination.

Discussion

To the best of our knowledge, the MIEO-Port system is the first device to provide a reliable and sterile flexible access to the peritoneal cavity that can be used throughout the entire gastrointestinal tract regardless of the access route and which combines hermetic sealing with local sterilization. Further studies are warranted.
Appendix
Available only for authorised users
Literature
1.
go back to reference Schlottmann F, Luckett DJ, Fine J, Shaheen NJ, Patti MG (2018) Laparoscopic Heller myotomy versus peroral endoscopic myotomy (POEM) for achalasia: a systematic review and meta-analysis. LWW, In.CrossRef Schlottmann F, Luckett DJ, Fine J, Shaheen NJ, Patti MG (2018) Laparoscopic Heller myotomy versus peroral endoscopic myotomy (POEM) for achalasia: a systematic review and meta-analysis. LWW, In.CrossRef
2.
go back to reference Penna M, Hompes R, Arnold S, Wynn G, Austin R, Warusavitarne J, Moran B, Hanna G, Mortensen N, Tekkis P (2017) Transanal total mesorectal excision: international registry results of the first 720 cases. Ann Surg 10 Penna M, Hompes R, Arnold S, Wynn G, Austin R, Warusavitarne J, Moran B, Hanna G, Mortensen N, Tekkis P (2017) Transanal total mesorectal excision: international registry results of the first 720 cases. Ann Surg 10
3.
go back to reference Senft JD, Gath P, Dröscher T, Müller PC, Carstensen B, Nickel F, Müller-Stich BP, Linke GR (2016) New device for transrectal trocar placement and rectal sealing for NOTES: a porcine in vivo and human cadaver study. Surg Endosc 30(10):4383–4388PubMedCrossRef Senft JD, Gath P, Dröscher T, Müller PC, Carstensen B, Nickel F, Müller-Stich BP, Linke GR (2016) New device for transrectal trocar placement and rectal sealing for NOTES: a porcine in vivo and human cadaver study. Surg Endosc 30(10):4383–4388PubMedCrossRef
4.
go back to reference Senft JD, Carstensen B, Mischnik A, Warschkow R, Müller-Stich BP, Linke GR (2016) Endolumenal colon occlusion reduces peritoneal contamination during a transrectal NOTES procedure: a controlled porcine survival study. Surg Endosc 30(7):2946–2950PubMedCrossRef Senft JD, Carstensen B, Mischnik A, Warschkow R, Müller-Stich BP, Linke GR (2016) Endolumenal colon occlusion reduces peritoneal contamination during a transrectal NOTES procedure: a controlled porcine survival study. Surg Endosc 30(7):2946–2950PubMedCrossRef
5.
go back to reference Müller PC, Senft JD, Gath P, Steinemann DC, Nickel F, Billeter AT, Müller-Stich BP, Linke GR (2018) Transrectal rigid-hybrid NOTES cholecystectomy can be performed without peritoneal contamination: a controlled porcine survival study. Surg Endosc 32(1):478–484PubMedCrossRef Müller PC, Senft JD, Gath P, Steinemann DC, Nickel F, Billeter AT, Müller-Stich BP, Linke GR (2018) Transrectal rigid-hybrid NOTES cholecystectomy can be performed without peritoneal contamination: a controlled porcine survival study. Surg Endosc 32(1):478–484PubMedCrossRef
6.
go back to reference Du B, Fan YJ, Zhao LX, Geng XY, Li DL, Wu XW, Zhang DK, Liu BR: A reliable detachable balloon that prevents abdominal cavity contamination during transrectal natural orifice transluminal endoscopic surgery. J Digest Dis 2019. Du B, Fan YJ, Zhao LX, Geng XY, Li DL, Wu XW, Zhang DK, Liu BR: A reliable detachable balloon that prevents abdominal cavity contamination during transrectal natural orifice transluminal endoscopic surgery. J Digest Dis 2019.
7.
go back to reference Oliveira AL, Zorron Oliveira RFMD, Santos MB Jr., Scheffer JP, Rios M, Antunes F (2017) Transcolonic perirectal NOTES access (PNA): a feasibility study with survival in swine model. Anais da Academia Brasileira de Ciências 89(1):685–693PubMedCrossRef Oliveira AL, Zorron Oliveira RFMD, Santos MB Jr., Scheffer JP, Rios M, Antunes F (2017) Transcolonic perirectal NOTES access (PNA): a feasibility study with survival in swine model. Anais da Academia Brasileira de Ciências 89(1):685–693PubMedCrossRef
8.
go back to reference Denk PM, Swanström LL, Whiteford MH (2008) Transanal endoscopic microsurgical platform for natural orifice surgery. Gastrointest Endosc 68(5):954–959PubMedCrossRef Denk PM, Swanström LL, Whiteford MH (2008) Transanal endoscopic microsurgical platform for natural orifice surgery. Gastrointest Endosc 68(5):954–959PubMedCrossRef
9.
go back to reference Wilhelm D, Meining Delius AS, Fiolka A, Can S, von Weyhern CH, Schneider A, Feussner H (2007) An innovative, safe and sterile sigmoid access (ISSA) for NOTES. Endoscopy 39(05):401–406CrossRef Wilhelm D, Meining Delius AS, Fiolka A, Can S, von Weyhern CH, Schneider A, Feussner H (2007) An innovative, safe and sterile sigmoid access (ISSA) for NOTES. Endoscopy 39(05):401–406CrossRef
10.
go back to reference Zheng YZ, Wang D, Gu JJ, Zhou MM, Yu KONGX, Xin DENGS, Ju SUX, Yin J, Gong YF, Wu RP (2011) An experimental study of betadine irrigation for preventing infection during the natural orifice transluminal endoscopic surgery (NOTES) procedure. J Digest Dis 12(3):217–222CrossRef Zheng YZ, Wang D, Gu JJ, Zhou MM, Yu KONGX, Xin DENGS, Ju SUX, Yin J, Gong YF, Wu RP (2011) An experimental study of betadine irrigation for preventing infection during the natural orifice transluminal endoscopic surgery (NOTES) procedure. J Digest Dis 12(3):217–222CrossRef
11.
go back to reference Bachman SL, Sporn E, Furrer JL, Astudillo JA, Calaluce R, McIntosh MA, Miedema BW, Thaler K (2009) Colonic sterilization for natural orifice translumenal endoscopic surgery (NOTES) procedures: a comparison of two decontamination protocols. Surg Endosc 23(8):1854–1859PubMedCrossRef Bachman SL, Sporn E, Furrer JL, Astudillo JA, Calaluce R, McIntosh MA, Miedema BW, Thaler K (2009) Colonic sterilization for natural orifice translumenal endoscopic surgery (NOTES) procedures: a comparison of two decontamination protocols. Surg Endosc 23(8):1854–1859PubMedCrossRef
12.
go back to reference Fong DG, Pai RD, Thompson CC (2007) Transcolonic endoscopic abdominal exploration: a NOTES survival study in a porcine model. Gastrointest Endosc 65(2):312–318PubMedCrossRef Fong DG, Pai RD, Thompson CC (2007) Transcolonic endoscopic abdominal exploration: a NOTES survival study in a porcine model. Gastrointest Endosc 65(2):312–318PubMedCrossRef
13.
go back to reference Fritscher-Ravens A, Arlt A (2011) Safety notes: how to avoid infections in natural orifice transluminal endoscopic surgery. Endoscopy 43(01):58–62PubMedCrossRef Fritscher-Ravens A, Arlt A (2011) Safety notes: how to avoid infections in natural orifice transluminal endoscopic surgery. Endoscopy 43(01):58–62PubMedCrossRef
14.
go back to reference Meining A, Wilhelm D, Burian M, Dundoulakis M, Schneider A, Von Delius S, Feussner H (2007) Development, standardization, and evaluation of NOTES cholecystectomy using a transsigmoid approach in the porcine model: an acute feasibility study. Endoscopy 39(10):860–864PubMedCrossRef Meining A, Wilhelm D, Burian M, Dundoulakis M, Schneider A, Von Delius S, Feussner H (2007) Development, standardization, and evaluation of NOTES cholecystectomy using a transsigmoid approach in the porcine model: an acute feasibility study. Endoscopy 39(10):860–864PubMedCrossRef
15.
go back to reference Xu B, Xu B, Zheng WY, Ge HY, Wang LW, Song ZS, He B (2015) Transvaginal cholecystectomy vs conventional laparoscopic cholecystectomy for gallbladder disease: a meta-analysis. World J Gastroenterol 21(17):5393–5406PubMedPubMedCentralCrossRef Xu B, Xu B, Zheng WY, Ge HY, Wang LW, Song ZS, He B (2015) Transvaginal cholecystectomy vs conventional laparoscopic cholecystectomy for gallbladder disease: a meta-analysis. World J Gastroenterol 21(17):5393–5406PubMedPubMedCentralCrossRef
16.
go back to reference Borchert DH, Federlein M, Ruckbeil O, Schope J (2017) Less pain after transvaginal cholecystectomy: single-center pooled analysis. Surg Endosc 31(6):2573–2576PubMedCrossRef Borchert DH, Federlein M, Ruckbeil O, Schope J (2017) Less pain after transvaginal cholecystectomy: single-center pooled analysis. Surg Endosc 31(6):2573–2576PubMedCrossRef
17.
go back to reference Bulian DR, Knuth J, Cerasani N, Sauerwald A, Lefering R, Heiss MM (2015) Transvaginal/transumbilical hybrid–NOTES–versus 3-trocar needlescopic cholecystectomy: short-term results of a randomized clinical trial. Ann Surg 261(3):451–458PubMedPubMedCentralCrossRef Bulian DR, Knuth J, Cerasani N, Sauerwald A, Lefering R, Heiss MM (2015) Transvaginal/transumbilical hybrid–NOTES–versus 3-trocar needlescopic cholecystectomy: short-term results of a randomized clinical trial. Ann Surg 261(3):451–458PubMedPubMedCentralCrossRef
18.
go back to reference Zattoni D, Popeskou GS, Christoforidis D (2018) Left colon resection with transrectal specimen extraction: current status. Tech Coloproctol 22(6):411–423PubMedCrossRef Zattoni D, Popeskou GS, Christoforidis D (2018) Left colon resection with transrectal specimen extraction: current status. Tech Coloproctol 22(6):411–423PubMedCrossRef
19.
go back to reference Liu BR, Liu D, Zhao LX, Ullah S, Zhang JP, Zhang JY (2019) Pure natural orifice transluminal endoscopic surgery (NOTES) nonstenting endoscopic gastroenterostomy: first human clinical experience. VideoGIE 4(5):206–208PubMedPubMedCentralCrossRef Liu BR, Liu D, Zhao LX, Ullah S, Zhang JP, Zhang JY (2019) Pure natural orifice transluminal endoscopic surgery (NOTES) nonstenting endoscopic gastroenterostomy: first human clinical experience. VideoGIE 4(5):206–208PubMedPubMedCentralCrossRef
20.
go back to reference Carmichael H, D'Andrea AP, Skancke M, Obias V, Sylla P (2019) Feasibility of transanal total mesorectal excision (taTME) using the Medrobotics Flex(R) System. Surg Endosc Carmichael H, D'Andrea AP, Skancke M, Obias V, Sylla P (2019) Feasibility of transanal total mesorectal excision (taTME) using the Medrobotics Flex(R) System. Surg Endosc
21.
go back to reference Feussner H, Krieger Y, Wilhelm D, Brunner S, Ostler D, Meining A, Lueth T (2019) Mechatronic support system for NOTES and monoport surgery—a new approach. Surg Technol int 34:23–29PubMed Feussner H, Krieger Y, Wilhelm D, Brunner S, Ostler D, Meining A, Lueth T (2019) Mechatronic support system for NOTES and monoport surgery—a new approach. Surg Technol int 34:23–29PubMed
22.
23.
go back to reference Fry DE (2017) Pressure Irrigation of Surgical Incisions and Traumatic Wounds. Surg Infect 18(4):424–430CrossRef Fry DE (2017) Pressure Irrigation of Surgical Incisions and Traumatic Wounds. Surg Infect 18(4):424–430CrossRef
24.
go back to reference Muller PC, Dube A, Steinemann DC, Senft JD, Gehrig T, Benner L, Nickel F, Muller-Stich BP, Linke GR (2018) Contamination after disinfectant rectal washout in left colectomy as a model for transrectal NOTES: a randomized controlled trial. J Surg Res 232:635–642PubMedCrossRef Muller PC, Dube A, Steinemann DC, Senft JD, Gehrig T, Benner L, Nickel F, Muller-Stich BP, Linke GR (2018) Contamination after disinfectant rectal washout in left colectomy as a model for transrectal NOTES: a randomized controlled trial. J Surg Res 232:635–642PubMedCrossRef
25.
go back to reference Fiolka A, Can S, Schneider A, Wilhelm D, Feussner H (2008) Instrumentation and surgical technique for an innovative safe sigmoid approach for NOTES. Minim Invasive Ther Allied Technol 17(6):336–340PubMedCrossRef Fiolka A, Can S, Schneider A, Wilhelm D, Feussner H (2008) Instrumentation and surgical technique for an innovative safe sigmoid approach for NOTES. Minim Invasive Ther Allied Technol 17(6):336–340PubMedCrossRef
26.
go back to reference Wilhelm D, Meining A, Schneider A, von Delius S, Preissel A, Sager J, Fiolka A, Friess H, Feussner H (2010) NOTES for the cardia: antireflux therapy via transluminal access. Endoscopy 42(12):1085–1091PubMedCrossRef Wilhelm D, Meining A, Schneider A, von Delius S, Preissel A, Sager J, Fiolka A, Friess H, Feussner H (2010) NOTES for the cardia: antireflux therapy via transluminal access. Endoscopy 42(12):1085–1091PubMedCrossRef
27.
go back to reference Magdeburg R, Kaehler G (2016) Natural orifice transluminal endoscopic surgery in humans: feasibility and safety of transgastric closure using the OTSC system. Surg Endosc 30(1):73–77PubMedCrossRef Magdeburg R, Kaehler G (2016) Natural orifice transluminal endoscopic surgery in humans: feasibility and safety of transgastric closure using the OTSC system. Surg Endosc 30(1):73–77PubMedCrossRef
28.
go back to reference Bauder M, Schmidt A, Caca K (2016) Non-exposure, device-assisted endoscopic full-thickness resection. Gastrointest Endosc Clin N Am 26(2):297–312PubMedCrossRef Bauder M, Schmidt A, Caca K (2016) Non-exposure, device-assisted endoscopic full-thickness resection. Gastrointest Endosc Clin N Am 26(2):297–312PubMedCrossRef
29.
go back to reference Kobara H, Mori H, Nishiyama N, Fujihara S, Okano K, Suzuki Y, Masaki T (2019) Over-the-scope clip system: a review of 1517 cases over 9 years. J Gastroenterol Hepatol 34(1):22–30PubMedCrossRef Kobara H, Mori H, Nishiyama N, Fujihara S, Okano K, Suzuki Y, Masaki T (2019) Over-the-scope clip system: a review of 1517 cases over 9 years. J Gastroenterol Hepatol 34(1):22–30PubMedCrossRef
30.
go back to reference Raithel M, Albrecht H, Scheppach W, Farnbacher M, Haupt W, Hagel AF, Schellerer V, Vitali F, Neurath MF, Schneider HT (2017) Outcome, comorbidity, hospitalization and 30-day mortality after closure of acute perforations and postoperative anastomotic leaks by the over-the-scope clip (OTSC) in an unselected cohort of patients. Surg Endosc 31(6):2411–2425PubMedCrossRef Raithel M, Albrecht H, Scheppach W, Farnbacher M, Haupt W, Hagel AF, Schellerer V, Vitali F, Neurath MF, Schneider HT (2017) Outcome, comorbidity, hospitalization and 30-day mortality after closure of acute perforations and postoperative anastomotic leaks by the over-the-scope clip (OTSC) in an unselected cohort of patients. Surg Endosc 31(6):2411–2425PubMedCrossRef
Metadata
Title
MIEO: a micro-invasive endoscopic operation port system for transluminal interventions—an acute and survival porcine study
Authors
D. Wilhelm
T. Vogel
A. Jell
S. Brunner
M. Kranzfelder
N. Wantia
H. Feussner
D. Ostler
S. Koller
Publication date
01-06-2020
Publisher
Springer US
Published in
Surgical Endoscopy / Issue 6/2020
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-020-07518-3

Other articles of this Issue 6/2020

Surgical Endoscopy 6/2020 Go to the issue