New laser soldering-based closures: a promising method in natural orifice transluminal endoscopic surgery - 20/06/12
Reprint requests: Martin Frenz, PhD, Department of Biomedical Photonics, Institute of Applied Physics, University of Bern Switzerland, Sidlerstrasse 5, 3012 Bern, SwitzerlandRésumé |
Background |
Complete closure of gastrotomy is the linchpin of safe natural orifice transgastric endoscopic surgery.
Objective |
To evaluate feasibility and efficacy of a new method of gastrotomy closure by using a sutureless laser tissue-soldering (LTS) technique in an ex vivo porcine stomach.
Design |
In vitro experiment.
Setting |
Experimental laboratory.
Interventions |
Histological analysis and internal and external liquid pressure with and without hydrochloric acid exposure were determined comparing gastrotomy closure with LTS and with hand-sewn surgical sutures.
Main Outcome Measurements |
Comparison of LTS and hand-sewn surgical gastrotomy closure. The primary outcome parameter was the internal leak pressure. Secondary parameters were the difference between internal and external leak pressures, the impact of an acid environment on the device, histological changes, and feasibility of endoscopic placement.
Results |
The internal liquid leak pressure after LTS was almost twice as high as after hand-sewn surgical closure (416 ± 53 mm Hg vs 229 ± 99 mm Hg; P = .01). The internal leak pressure (416 ± 53 mm Hg) after LTS was higher than the external leak pressure (154 ± 46 mm Hg; P < .0001). An acidic environment did not affect leak pressure after LTS. Endoscopic LTS closure was feasible in all experiments. Histopathology revealed only slight alterations beneath the soldering plug.
Limitations |
In vitro experiments.
Conclusions |
Leak pressure after LTS closure of gastrotomy is higher than after hand-sewn surgical closure. LTS is a promising technique for closure of gastrotomies and iatrogenic perforations. Further experiments, in particular survival studies, are mandatory.
Le texte complet de cet article est disponible en PDF.Abbreviations : EASIE, LTS, NOTES, PCL
Plan
| DISCLOSURE: The authors disclosed no financial relationships relevant to this publication. Supported by Swiss Commission of the Encouragement of Scientific Research contract grant 11478.1pfls-ls. |
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| If you would like to chat with an author of this article, you may contact Dr Frenz at frenz@iap.unibe.ch. |
Vol 76 - N° 1
P. 151-158 - juillet 2012 Retour au numéro
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