Original article
Experimental endoscopy
Evaluation of a new multitasking platform for endoscopic full-thickness resection

https://doi.org/10.1016/j.gie.2010.09.016Get rights and content

Background

The advent of natural orifice transluminal endoscopic surgery (NOTES) has accelerated the development of new technology in the field of GI endoscopy. Various suturing devices or multitasking platforms are expected to be valuable for endoluminal surgery as well as for NOTES.

Objective

To evaluate a new multitasking platform in performing endoscopic full-thickness resection (EFTR).

Design

Bench-top comparison study.

Setting

Research laboratory study of 10 ex vivo porcine models.

Intervention

Ten EFTRs (5 with a double-channel endoscope vs 5 with a new multitasking platform) assisted with percutaneous gastric lifting. Each group was given the task of resecting a full-thickness specimen of the gastric wall including a pseudolesion 10 mm in diameter with an effective margin.

Main Outcome Measurements

Outcome measurements included time to perform the procedure, accuracy of the resection, and efficiency for the task. Accuracy was assessed according to variability of the surgical margin and misalignment between the mucosal layer and the seromuscular layer. Efficiency was assessed according to the duty ratio, which is the percentage of time spent for the main purposes compared with the total procedure time.

Results

Mean diameter of the specimen was not significantly different between the groups. All other assessment items were significantly superior in group B to those in group A (P < .05).

Limitations

Ex vivo animal model study.

Conclusion

We were able to perform EFTR procedures precisely and effectively by using a new multitasking platform compared with use of a conventional endoscope in a porcine model. A multitasking platform developed for NOTES procedures would be useful for advanced endoluminal surgery such as endoscopic submucosal dissection or EFTR as well as NOTES.

Section snippets

Specification of the EndoSAMURAI

The EndoSAMURAI prototype can provide great advantages by enabling traction and counter-traction through its independently movable arms and drive handles that transmit the movement of the operator's hands to the arms (Fig. 1). The EndoSAMURAI has 3 parts, which are the main body, the insertion tube, and the tip portion.

An insertion tube is 15 mm in diameter. Two articulating arms are equipped in the tip portion, which is designed so that each arm can insert various forceps from the main body

Results

The mean diameter of the resected specimen was 24.2 mm for group A and 21.5 mm for group B (P = .09). Only this item was not significantly different between the groups.

All other assessment items were significantly superior in group B compared with those in group A (P < .05) (Table 1). The mean procedure time was 23 minutes 28 seconds for group A and 13 minutes 25 seconds for group B (P = .002). Variability of the resected specimen was 15.3 mm for group A and 7.8 mm for group B (P = .028) (Fig. 8

Discussion

We reported the first comparative study of EndoSAMURAI for EFTR by using an ex vivo porcine model. This bench-top evaluation showed that EndoSAMURAI has great potential to allow more accurate and more effective performance of EFTR compared with that of a conventional, double-channel endoscope. In a double-channel endoscope, 2 forceps cannot be manipulated simultaneously in good cooperation. In contrast, EndoSAMURAI has a much more ergonomic design, and 2 arms can be manipulated simultaneously

Conclusions

A new multitasking platform, the EndoSAMURAI, allowed performance of EFTR procedures precisely and effectively compared with a conventional endoscope in a porcine model. Its more panoramic view and effective counter-traction could contribute to these successful results. The multitasking platform, which is the new technology developed for NOTES procedures, would be useful for advanced endoluminal surgery such as ESD and EFTR as well as NOTES.

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DISCLOSURE: K. Ikeda is a consultant for Olympus Medical Systems Corp. No other financial relationships relevant to this publication were disclosed.

If you would like to chat with an author of this article, you may contact Dr Ikeda at [email protected].

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