Endoscopic suturing without extracorporeal knots: a laboratory study - 18/08/11

Doi : 10.1016/S0016-5107(05)00331-7

Bing Hu, MD, S.C. Sydney Chung, MD ^⁎, Lawrence C.L. Sun, MPhil, James. Y.W. Lau, MD, Koichi Kawashima, BS, Tetsuya Yamamoto, BS, Peter B. Cotton, MD, Christopher J. Gostout, MD, Robert H. Hawes, MD, Anthony N. Kalloo, MD, Sergey V. Kantsevoy, MD, Pankaj J. Pasricha, MD
Current affiliations: Endoscopy Center, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China, Research and Development Department, Olympus Medical Systems Corp., Tokyo, Japan; The Apollo Group, Hong Kong, China (S.C.S.C.); Charleston, South Carolina (P.B.C., R.H.H.); Rochester, Minnesota (C.J.G.); Baltimore, Maryland (A.N.K., S.V.K.); Galveston, Texas (P.J.P.), USA

Reprint requests: S. C. Sydney Chung, MD, Endoscopy Center, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin N.T., Hong Kong SAR, China.

Hong Kong, China

Abstract

Background

To eliminate cumbersome extracorporeal knotting, we designed a new endoscopic suturing device, the Eagle Claw V. The efficacy of the new device was tested on the Erlangen model and was compared with the initial extracorporeal knotting version (Eagle Claw II).

Methods

Segments of porcine splenic arteries were placed on the mucosal surface of the anterior wall of a pig stomach. The two ends of the artery were brought out through the gastric wall and were connected to a two-channel manometer. The Eagle Claw V has a curved needle with a detachable tip. After puncturing the tissue, the needle tip was engaged into a catching cartridge, where the suture had been embedded in a tightening mechanism. The suture could be tightened by simply pulling the end. The Eagle Claw V was used to plicate the splenic arteries mounted on the stomach. Suturing was considered secure if the suture could withstand endoluminal pressure greater than 200 mm Hg that lasted at least 10 seconds.

Results

Eleven of 15 stitches (73.3%) gained secure plication of the vessels. The suturing time (mean ± standard deviation 2.93 ± 0.80 minutes) was significantly faster than that of the Eagle Claw II (9.38 ± 1.51 minutes). The device consistently achieved penetration of the muscular layer, and 4 of 15 sutures included the serosa. The 4 failures were because of suture breakage in two, thread entanglement in one, and cartridge dislodgement in one.

Conclusions

The present prototype represents significant improvements in the ease of operation and the security of the suture, bringing the technique closer to clinical use for a variety of applications.

Le texte complet de cet article est disponible en PDF.

Plan

Material and methods

Results

Discussion

This study was an oral presentation at the annual Digestive Disease Week, May 15-20, 2004, New Orleans, Louisiana (Gastrointest Endosc 2004;59:AB114).