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1.
Minim Invasive Ther Allied Technol ; 31(6): 930-938, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35112641

RESUMO

Purpose: To investigate the interaction of a robot assisted magnetically driven wireless capsule endoscope (WCE) with colonic tissue, as it traverses the colorectal bends in the dorsal and ventral directions, relying only on the feedback from a 3D accelerometer. We also investigate the impact of shell geometry and water insufflation on WCE locomotion.Methods: A 3D printed incline phantom, lined with porcine colon, was used as the experimental platform, for controlled and repeatable results. The tilt angle of WCE was controlled to observe its influence on WCE locomotion. The phantom was placed underwater to observe the effects of water insufflation. The experiments were repeated using the two capsule shell geometries to observe the effect of shell geometry on WCE locomotion.Results: Friction between WCE and intestinal tissue increased when the tilt angle of the WCE was lower than the angle of the incline of the phantom. Increasing the WCE tilt angle to match the angle of the incline reduced this friction. Water insufflation and elliptical capsule shell geometry reduced the friction further.Conclusion: Tilting of the WCE equal to, or more than the angle of the incline improved the WCE locomotion. WCE locomotion was also improved by using elliptical capsule shell geometry and water insufflation.Abbreviations: CRC: colorectal cancer; GI: gastrointestinal; MRI: magnetic resonance imaging; WCE: wireless capsule endoscope.


Assuntos
Endoscopia por Cápsula , Neoplasias Colorretais , Robótica , Animais , Cápsulas Endoscópicas , Endoscopia por Cápsula/métodos , Neoplasias Colorretais/diagnóstico , Suínos , Água
2.
Surg Endosc ; 34(2): 888-898, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31139988

RESUMO

BACKGROUND: Acute upper gastrointestinal bleeding is a life-threatening medical condition with a relevant risk of re-bleeding even after initial endoscopic hemostasis. The implantable HemoPill monitor contains a novel telemetric sensor to optically detect blood in the stomach allowing the surveillance of high-risk patients for re-bleedings. METHODS: In this pre-clinical porcine study, bleeding has been simulated by injecting porcine blood into the stomach of a pig through an implanted catheter using a syringe pump. The effect of the sensor position in the stomach, the gastric food content, and the bleeding intensity was investigated. RESULTS: Sensitivity and specificity of the sensor reached more than 87.5% when the sensor was positioned close to the source of bleeding. Solid food had a higher negative impact on sensitivity than liquid food but a positive impact on specificity. A heavy bleeding was more likely to be detected by the sensor but was also associated with a lower likelihood for true-negative results than weaker bleedings. CONCLUSIONS: The study clearly demonstrated the capability of the HemoPill sensor prototype to detect clinically relevant bleedings with high sensitivity and specificity (> 80%) when the sensor was positioned close to the bleeding site. The sensors proved to be robust against artefact effects from stomach content. These are favorable findings that underline the potential benefit for the use of the HemoPill sensor in monitoring patients with a risk of re-bleeding in the upper gastrointestinal tract.


Assuntos
Técnicas Biossensoriais/instrumentação , Hemorragia Gastrointestinal/diagnóstico , Telemetria , Animais , Modelos Animais , Sensibilidade e Especificidade , Suínos
3.
Minim Invasive Ther Allied Technol ; 29(3): 121-139, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30957599

RESUMO

Since its market launch in 2007, the endoscopic OTSC clipping system has been the object of intensive clinical research. These data were systematically collected for post-market clinical follow-up (PMCF). The aim of the study was the systematic review of the efficacy and safety of the OTSC System. The PMCF database was systematically searched for clinical data on OTSC therapy of GI hemorrhage (H), acute leaks/perforations (AL) and chronic leaks/fistulae (CL). Major outcomes were successful clip application and durable hemostasis/closure of defects. Comprehensive pooled success proportions were established by meta-analytical methods. Four-hundred-fifty-seven publications were reviewed. Fifty-eight articles comprising 1868 patients fulfilled criteria to be included in the analysis. These consisted of retrospective analyses, prospective observational trials, one randomized-controlled trial (STING) and one quasi-controlled study (FLETRock). The pooled proportion analysis revealed high overall proportions of technical success: H - mean 93.0% [95%CI 90.2-95.4], AL-mean 89.7% [95%CI 85.9-92.9] and CL-mean 83.8% [95%CI 76.9-89.7]. Pooled durable clinical success proportions were: H-mean 87.5% [95%CI 80.5-93.2], AL-mean 81.4% [95%CI 77.0-85.3] and CL-mean 63.0% [95%CI 53.0-72.3]. By pooling all clinical data gained, we conclude that OTSC application in GI hemorrhage and closure of GI lesions is safe and effective in real clinical use.


Assuntos
Endoscopia Gastrointestinal/métodos , Hemorragia Gastrointestinal/terapia , Hemostase Endoscópica/instrumentação , Hemostase Endoscópica/métodos , Procedimentos Cirúrgicos Minimamente Invasivos/instrumentação , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Instrumentos Cirúrgicos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Estudos Retrospectivos , Resultado do Tratamento
4.
Minim Invasive Ther Allied Technol ; 27(3): 138-142, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-28608741

RESUMO

INTRODUCTION: The remOVE System (Ovesco Endoscopy AG, Tuebingen, Germany) is a medical device for the endoscopic removal of OTSC or FTRD clips (Ovesco Endoscopy AG, Tuebingen, Germany). The aim of this paper is to assess the efficacy and safety of this system. MATERIAL AND METHODS: A total of 74 patients underwent clip extraction. The standard removal procedure comprises fragmenting the clip by applying an electrical direct current pulse at two opposing sides of the clip. RESULTS: Clip fragmentation was successful in 72 of 74 patients (97.3%). In two cases (2.7%) clip fragmentation was not possible. In nine cases (12.2%) a clip fragment could not be removed and was left in place. Complications occurred in three cases (4.1%): two minor bleedings near the clip removal site (2.7%), and one superficial mucosal tear resulting from clip fragment extraction (1.4%). DISCUSSION: Based on this study, the use of the remOVE System for OTSC or FTRD clip removal can be considered safe and effective.


Assuntos
Remoção de Dispositivo/instrumentação , Endoscopia Gastrointestinal/instrumentação , Trato Gastrointestinal/cirurgia , Instrumentos Cirúrgicos , Remoção de Dispositivo/efeitos adversos , Endoscopia Gastrointestinal/efeitos adversos , Endoscopia Gastrointestinal/métodos , Humanos , Estudos Retrospectivos , Resultado do Tratamento
5.
Dig Dis Sci ; 61(10): 2956-2962, 2016 10.
Artigo em Inglês | MEDLINE | ID: mdl-27343036

RESUMO

BACKGROUND: An acute upper gastrointestinal bleeding event is an emergency situation which requires immediate endoscopic assessment and treatment. A new telemetric real-time intracorporeal bleeding sensor can help in the timely diagnosis of an acute upper gastrointestinal bleeding event: The sensor capsule, HemoPill, is swallowed by the patient if gastrointestinal bleeding is suspected. Information about the bleeding status is displayed by telemetric communication of the capsule with an extracorporeal receiver. This is the first evaluation of the HemoPill to detect blood in the upper human gastrointestinal tract. METHODS: A voluntary test person ate a defined meal with or without the adjunct of his own blood for a total of eight times and afterward swallowed the sensor capsule. The collected spectrometric receiver data were analyzed to assess whether the sensor system was capable of detecting blood and to evaluate the effect of stomach content as an artifact. RESULTS: With its optical sensor, the HemoPill was able to reliably indicate the ingested blood in the stomach. The data transmission from the swallowed sensor capsule to the extracorporeal receiver was achieved consistently. The evaluation of diverse concentrations of ingested blood and the respective sensor signals led to an exponential relationship of these variables. This relationship allows to define thresholds for categories indicating the likelihood of blood presence in the gastrointestinal tract. CONCLUSIONS: The HemoPill is a valuable tool to detect an acute upper gastrointestinal bleeding event without the need of endoscopy.


Assuntos
Doenças do Esôfago/diagnóstico , Hemorragia Gastrointestinal/diagnóstico , Voluntários Saudáveis , Imagem Óptica/instrumentação , Gastropatias/diagnóstico , Telemetria/instrumentação , Humanos
6.
Surg Innov ; 23(3): 291-7, 2016 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-26546367

RESUMO

Tactile feedback is completely lost in laparoscopic surgery, which would provide information about tissue compliance, texture, structural features, and foreign bodies. We developed a system with artificial tactile feedback for laparoscopic surgery that consists of a telemetric tactile laparoscopic grasper, a remote PC with customized software, and a commercial video-mixer. A standard, nonsensorized laparoscopic grasper was customized to allow the integration of a tactile sensor and its electronics. The tactile sensor and the electronics module were designed to be detachable from the instrument. These parts are lightweight and wireless, thus not impeding the use of the device as surgical instrument. The remaining system components used to generate visualization of the tactile data do not influence the workflow in the operating room. The overall system design of the described instrumentation allows for easy implementation in an operating room environment. The fabrication of the tactile sensor is relatively easy and the production costs are low. With this telemetric laparoscopic grasper instrument, systematic preclinical studies can be performed in which surgeons execute surgical tasks that are derived from clinical reality. The experience gained from these investigations could then be used to define the requirements for any further development of artificial tactile feedback systems.


Assuntos
Desenho de Equipamento/métodos , Retroalimentação , Laparoscópios/economia , Laparoscopia/instrumentação , Telemetria/instrumentação , Interface Usuário-Computador , Análise Custo-Benefício , Humanos , Instrumentos Cirúrgicos/economia , Análise e Desempenho de Tarefas , Tato
7.
Surg Endosc ; 29(8): 2434-41, 2015 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-25318369

RESUMO

BACKGROUND: The benefit of endoscopic full-thickness resection is the improved diagnostic work-up with an integral wall specimen which allows a precise determination of the tumor or its precursor and its infiltration depth into the wall. MATERIALS AND METHODS: A new endoscopic full-thickness resection device (FTRD), which is a combination of a modified over-the-scope-clip (OTSC) system with an electrocautery snare, has been tested in an experimental setting. In eleven pigs, divided into three groups, endoscopic full-thickness resection was performed in the colon at one or two sites, respectively. Seven days (n = 7) or 28 days (n = 4) after the intervention, the animals were euthanized following endoscopic examination of the resection and clip application sites. Furthermore, two different clips were tested during these animal trials in order to evaluate the most effective clip design. RESULTS: The average diameter of the tissue resected with the FTRD was 3.1, 3.6, and 5.4 cm in the three groups. On follow-up endoscopy 7 days after the intervention, fibrin coating and stool residues were found at all clips, causing minor inflammatory reactions. However, the colon wall under the clip was non-inflamed. After 28 days, the serosa had primarily healed in all cases. There were also stool residues at all clips; however, no acute inflammatory reactions were seen anymore, due to complete healing. Histological assessment did not show any signs of dehiscence in the region of the scar, or ischemia in the clip area. In addition, no wound infections, such as abscess formation, were observed. CONCLUSIONS: This study demonstrates the safety and efficacy of the clip-and-cut technique using the new FTRD system. With the device, a local full-thickness colon resection can be easily created, and the resulting wall defect is reliably sealed by the endoluminal application of a modified OTSC clip.


Assuntos
Colectomia/instrumentação , Colo/cirurgia , Eletrocoagulação , Endoscopia Gastrointestinal/instrumentação , Animais , Colectomia/métodos , Endoscopia Gastrointestinal/métodos , Estudos de Viabilidade , Modelos Animais , Suínos
8.
Surg Endosc ; 27(7): 2258-74, 2013 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-23340813

RESUMO

BACKGROUND: Reliable closure is a prerequisite for conventional and innovative endoscopic procedures, such as NOTES. The purpose of this study is the systematic evaluation of the procedural and clinical success rates in closure of iatrogenic gastrointestinal perforations and acute anastomotic leaks by means of the over-the-scope-clip system (OTSC(®)). DESIGN: PubMed and other sources were searched systematically for clinical and preclinical research on the evaluation of the OTSC System for closure of gastrointestinal perforations and leaks. Appraisal of studies for inclusion and data extraction was performed independently by two reviewers using an a priori determined data extraction grid. Major endpoints to be extracted were data on procedural success (successful clip application) and clinical access (durable closure of defect without secondary adjunct therapy). RESULTS: A total of 17 clinical research articles/abstracts and 22 preclinical research articles/abstracts were identified. The examined clinical studies comprised case series and clinical single-arm studies. The reviewed studies revealed a consistently high mean rate of procedural success of 80-100 % and durable clinical success of 57-100 %. An identified major drawback preventing successful clip application was occurrence of fibrotic or inflamed lesion edges. Usage of the OTSC System was accompanied by neither major clip-related nor application-related complication. In experimental settings, closure of larger perforations and gastric access sites of NOTES or endoscopic full-thickness resection were achieved with high rates of success. CONCLUSIONS: Because randomized, clinical trials are not available in this field of indication, the evaluation is based on small case series. Nevertheless, by pooling all experience gained, we conclude that endoscopic closure of iatrogenic gastrointestinal perforations and acute anastomotic leaks by means of the OTSC System is a safe and effective method.


Assuntos
Endoscopia Gastrointestinal/instrumentação , Perfuração Intestinal/cirurgia , Instrumentos Cirúrgicos , Animais , Endoscópios Gastrointestinais , Desenho de Equipamento , Humanos , Doença Iatrogênica , Cicatrização
9.
Minim Invasive Ther Allied Technol ; 22(4): 194-9, 2013 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-23964792

RESUMO

A quarter of a century has passed since the Society of Minimally Invasive Therapy (SMIT) was founded in 1989 with the aim to provide a platform to promote the development of minimally invasive therapy and the new instruments and devices needed to carry out the new surgical techniques. Both the founder of the society, British urologist John EA Wickham, and the German surgeon Gerhard F Buess, who was one of the leading members from the beginning, conceived SMIT as an interdisciplinary forum to promote the cooperation between physicians from various surgical specialties, but also medical engineers, resp. medical device manufacturers, whose expertise was needed to build the instruments that had to be developed to carry out the new concept of surgery. In this paper we outline the history of SMIT over the past 25 years in order to highlight both the ideas behind the society and the dedication of the people who shaped it.


Assuntos
Comportamento Cooperativo , Procedimentos Cirúrgicos Minimamente Invasivos/tendências , Sociedades Médicas/história , Desenho de Equipamento , História do Século XX , História do Século XXI , Humanos , Comunicação Interdisciplinar , Procedimentos Cirúrgicos Minimamente Invasivos/história , Procedimentos Cirúrgicos Minimamente Invasivos/instrumentação
10.
Stud Health Technol Inform ; 177: 97-100, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-22942037

RESUMO

Upper gastrointestinal bleeding is considered the most frequent emergency in endoscopy units. Decisive for successful treatment of acute upper gastrointestinal bleeding is a timely recognition. We have developed a telemetric implant containing a novel optical sensor principle able to detect the presence of blood in the lumen of the GI tract. In-vivo experiments demonstrated the possibility to detect bleeding in situ and to send an alert signal to an extracorporeal receiver.


Assuntos
Hemorragia Gastrointestinal/diagnóstico , Monitorização Ambulatorial/instrumentação , Fotometria/instrumentação , Próteses e Implantes , Telemedicina/instrumentação , Telemetria/instrumentação , Biotecnologia/instrumentação , Desenho de Equipamento , Análise de Falha de Equipamento , Humanos
11.
Minim Invasive Ther Allied Technol ; 21(4): 249-58, 2012 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-22694247

RESUMO

BACKGROUND: Conventional endoscopic treatment options for closure of gastrointestinal fistulae are impaired by several limitations and therefore yield high rates of recurrence. Aim of the study is the evaluation of the primary-technical and secondary-clinical success rates in closure of gastrointestinal fistulae by means of the OTSC System. DESIGN/METHODS: The database Medline was systematically searched for primary research on the evaluation of the OTSC System in closure of gastrointestinal fistulae. Appraisal of studies for inclusion and data extraction were performed independently by two reviewers using an a priori determined data extraction grid. RESULTS: A total of 19 primary research articles were identified. The examined studies comprised case reports as well as case series and clinical single-arm studies (n = 7) with a limited number of participants. Reviewed studies revealed a high rate of procedural success (mean 84.6%; 95% confidence interval 66.6 to 93.8%) and durable clinical success (mean 69.0%; 95% confidence interval 51.8 to 82.2%). Failed attempts and incomplete closures were mainly ascribed to the challenging effort of treating highly fibrotic chronic fistulae. CONCLUSION: Endoscopic closure of gastrointestinal fistulae by means of the OTSC System is a safe and effective method.


Assuntos
Fístula Gástrica/cirurgia , Gastroscopia/instrumentação , Fístula Intestinal/cirurgia , Ligas , Intervalos de Confiança , Fístula Gástrica/patologia , Gastroscopia/métodos , Humanos , Fístula Intestinal/patologia
13.
Surg Endosc ; 24(9): 2299-307, 2010 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-20354870

RESUMO

BACKGROUND: In laparoscopy, impaired feedback information from the operation site and reduced instrument dexterity lead to high demands on surgeons' skill and experience. Pre-clinical studies have shown that artificial tactile feedback (ATF) could significantly improve the quality of tactile feedback information. Additional information about interaction effects of tissue features when using ATF as well as related detection thresholds would be valuable for drawing conclusions on possible clinical application scenarios. OBJECTIVE: To identify surgical procedures in laparoscopy that could benefit from ATF in tissue examination through remote palpation. METHODS: We have developed a laparoscopic grasper capable of providing ATF by measuring the pressure distribution on one forceps jaw with a tactile sensor array. The data was presented graphically on the endoscopic screen. We conducted a study among surgeons and non-surgeons, comparing the capability to detect hidden objects through remote palpation with and without ATF. The data were analyzed using repeated-measures multiple analysis of variance (MANOVA) in two designs. RESULTS: ATF could enhance feedback information with significant positive effects on accuracy, speed, the reduction of the number of grasps, and user confidence. The positive effect of ATF turned out to be especially strong if hidden objects were either hard and too small or large and too soft to be recognized by remote palpation without ATF. CONCLUSIONS: Our study contributes to the discussion on promising application scenarios of ATF-enhanced instrumentation in laparoscopic surgery. Based on our study results, such instrumentation may be valuable for detection and examination of hidden bodies or structures through remote palpation.


Assuntos
Retroalimentação , Laparoscopia/métodos , Palpação/métodos , Tato , Análise de Variância , Desenho de Equipamento , Humanos , Laparoscopia/instrumentação , Palpação/instrumentação
15.
Annu Int Conf IEEE Eng Med Biol Soc ; 2019: 3697-3702, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31946678

RESUMO

Wireless capsule endoscopes provide a painless and non-invasive alternative to the flexible endoscope in various applications of the gastrointestinal tract diagnosis. Operating a wireless capsule endoscope in the colon may benefit from an active position control as the large colon diameter can lead to uncontrollable and unpredictable capsule trajectory. Robot assisted magnetic steering is an attractive technique that is being explored by researchers worldwide. This paper presents the implications of a novel capsule geometry to markedly improve capsule stabilization and locomotion compared to the cylinder-based capsule geometry that is commonly used.


Assuntos
Cápsulas Endoscópicas , Endoscopia por Cápsula , Desenho de Equipamento , Trato Gastrointestinal/diagnóstico por imagem , Magnetismo , Robótica , Humanos
16.
J Biomed Semantics ; 10(1): 9, 2019 05 30.
Artigo em Inglês | MEDLINE | ID: mdl-31146771

RESUMO

BACKGROUND: The vigilant observation of medical devices during post-market surveillance (PMS) for identifying safety-relevant incidents is a non-trivial task. A wide range of sources has to be monitored in order to integrate all accessible data about the safety and performance of a medical device. PMS needs to be supported by an efficient search strategy and the possibility to create complex search queries by domain experts. RESULTS: We use ontologies to support the specification of search queries and the preparation of the document corpus, which contains all relevant documents. In this paper, we present (1) the Search Ontology (SON) v2.0, (2) an Excel template for specifying search queries, and (3) the Search Ontology Generator (SONG), which generates complex queries out of the Excel template. Based on our approach, a service-oriented architecture was designed, which supports and assists domain experts during PMS. Comprehensive testing confirmed the correct execution of all SONG functions. The applicability of our method and of the developed tools was evaluated by domain experts. The test persons concordantly rated our solution after a short period of training as highly user-friendly, intuitive and well applicable for supporting PMS. CONCLUSIONS: The Search Ontology is a promising domain-independent approach to specify complex search queries. Our solution allows advanced searches for relevant documents in different domains using suitable domain ontologies.


Assuntos
Ontologias Biológicas , Mineração de Dados/métodos , Vigilância de Produtos Comercializados , Equipamentos e Provisões/efeitos adversos , Segurança
17.
Biomed Tech (Berl) ; 53(2): 45-51, 2008 Apr.
Artigo em Alemão | MEDLINE | ID: mdl-18979620

RESUMO

Iatrogenic perforation of the colon during interventional endoscopic procedures, e.g., mucosectomy, is a problematic complication, as safe treatment often requires surgical repair. Iatrogenic perforation of the colon is indeed a rare complication; however, given the increasing case numbers in interventional endoscopy it is of considerable practical relevance. The closure of perforations can be achieved with conventional endoscopic clips; however, these working channel based clips are often too small to close a perforation securely. Therefore, we have developed a novel endoscopic clipping system that can be attached to the tip of the endoscope. This over-the-scope-clip system (OTSC), made of Nitinol, was tested in an experimental trial (domestic pig, 50-60 kg) for its applicability for perforation closure. In acute experiments, tight endoscopic closure of 10 perforations in five animals was demonstrated; perforations were made through repeat biopsy. In three further animals, the postoperative course was studied over a period of 2 weeks. Peritonitis was not found in any of these animals. The local healing result at the site of implantation was good. Clips were present 2 weeks after the procedure. In this experimental study, the OTSC clip system was found to be a simple and secure method of iatrogenic colon perforation closure.


Assuntos
Colonoscópios , Perfuração Intestinal/cirurgia , Intestino Grosso/lesões , Intestino Grosso/cirurgia , Instrumentos Cirúrgicos , Animais , Desenho de Equipamento , Análise de Falha de Equipamento , Suínos
19.
Artigo em Inglês | MEDLINE | ID: mdl-18270877

RESUMO

This paper describes a device and surgical techniques developed between 1999 and 2003 to enable an entirely transoral approach to fundoplication. The Endofundoplication System (EFS) system consisted of a multifunctional flexible tube for oral introduction (18 mm) as the key component, with a specially designed retroverted grasper that was used to grasp the lower esophageal sphincter (LES) area of the esophagus, for invaginating the LES into the stomach and folding the gastric wall onto the wall of the intraabdominal esophagus. The EFS system was finally studied in a consecutive series of animal experiments in the domestic pig (n = 10). In nine out of the ten cases the procedure could be successfully completed and the animals survived six weeks according to the study protocol. The clinical follow-up of the nine animals went without problems. The animals behaved normally the first day after the procedure and tolerated regular diet very well. No signs of pain or any abdominal pathology were found in the clinical follow-up. Follow-up by endoscopy and fluoroscopy showed a subsequent postoperative migration of fasteners within the tissue. After autopsy and macroscopic inspection of the gastroesophageal junction (GEJ), we found firm tissue indurations around the fasteners. This may indicate that the fastener as a foreign body leads to a sufficient amount of scar tissue formation to contribute to permanent fixation of the tissue layers. The basic advantage of the EFS technique was seen by our group in the fact that it comes closer to the shape and function of a classical fundoplication than any other techniques proposed at the time we did our development. The nipple valve created by the EFS technique is, however, geometrically not identical to any existing fundoplication technique and is not directly comparable to any such procedure.


Assuntos
Fundoplicatura/instrumentação , Fundoplicatura/métodos , Animais , Comportamento Animal , Cicatriz/etiologia , Ingestão de Alimentos/fisiologia , Endoscopia do Sistema Digestório , Junção Esofagogástrica/patologia , Fluoroscopia , Seguimentos , Migração de Corpo Estranho/etiologia , Fundoplicatura/efeitos adversos , Complicações Pós-Operatórias/etiologia , Taxa de Sobrevida , Suínos
20.
Artigo em Inglês | MEDLINE | ID: mdl-18972252

RESUMO

The closure of the gastrotomy in Natural Orifice Endoscopic Surgery (NOTES) is a prerequisite for transgastric endoscopic procedures in the abdominal cavity. Different techniques have been proposed and are under experimental or early clinical investigation. These include the use of conventional endoscopic clips, newly designed clips or T-BARS in different shapes or more complicated devices such as linear endoscopic staplers and septal occluders, originally used for the treatment of cardiac septal defects. We describe here a further alternative of endoscopic organ closure in NOTES, using the OTSC, a novel type of clip attached to the tip of the endoscope. The OTSC clip as a CE-marked device is widely used clinically for various endoscopic procedures, such as the treatment of gastrointestinal bleeding and iatrogenic defects of the digestive tract, e.g. colonic perforations after endoscopic interventions. Now an enlarged version of the OTSC clip can be applied for the closure of transluminal access to the abdominal cavity and is currently being evaluated for use in NOTES. In animal tests we could demonstrate the relatively easy achievement of a full thickness closure of the gastric wall after NOTES in the experimental model. The current data base on OTSC and on other techniques proposed for organ closure after NOTES does not yet allow determining clear advantages or disadvantages of the different options. We believe the hollow organ defect closure now represents the most important issue to decode whether or not we are going to proceed with NOTES. Ongoing surviving animal labs will give us indications on how to proceed.


Assuntos
Endoscópios Gastrointestinais , Endoscopia Gastrointestinal/métodos , Instrumentos Cirúrgicos , Cavidade Abdominal/cirurgia , Animais , Desenho de Equipamento , Gastrostomia/métodos , Humanos , Técnicas de Sutura
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