Endoluminal compression clip: full-thickness resection of the mesenteric bowel wall in a porcine model - 23/08/11
Reprint requests: Doron Kopelman, MD, Head Department of Surgery B, HaEmek Medical Center, Yitzhak Rabin Avenue, 18101, Afula, Israel.Tel Aviv, Israel
Abstract |
Background |
Performing a full-thickness intestinal wall resection of a sessile polyp located on the mesenteric side with a compression clip may lead to compression of mesenteric vessels. The application of such a clip may therefore cause a compromised blood supply in the particular bowel segment, leading to perforation.
Objective |
To evaluate the performance of a newly developed, nitinol compression clip, called the NiTi clamp, for full-thickness resection of the bowel wall, while the clip is deliberately deployed endoluminally on the mesenteric side.
Design |
Prospective animal study. Multinational, multidisciplinary; gastroenterology and general surgery, research cooperation.
Setting |
Animal research laboratory.
Intervention |
Six pigs were operated upon and endoscopically evaluated and then killed after 3 weeks. Linear compression closure clips based on nitinol springs were used. Three longitudinal enterotomies were performed: in the cecum, spiral colon, and proximal rectum. Four clips were deployed in each animal.
Main Outcome Measurements |
A total of 23 clips were deployed. The average expulsion day was 9 days.
Results |
All but 3 clips were normally expelled. One pig developed bowel ischemia due to intussusception. In endoscopic procedures, no signs of significant segmental mucosal ischemia were found. The macroscopic appearance of the compression closure lines was thin and delicate, but epithelialization was significantly delayed at 5 sites.
Limitation |
Differences between porcine and human colorectal anatomy.
Conclusion |
Full-thickness clamping of the bowel with the NiTi clamp, including the local mesenteric vasculature, does not significantly impair local healing of the clamp site and gives hope to further development of novel full-thickness endoscopic resection technologies.
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| DISCLOSURE: The following authors disclosed financial relationships relevant to this publication: D. Kopelman has a consulting/advisory and research support arrangement with Niti Surgical Solutions Ltd, Israel, InSightec Ltd, Israel, Serafix Ltd, Israel, and Lifebond Ltd, Israel. P. D. Siersema has a consulting/advisory/speaking arrangement with Janssen-Cilag BV, The Netherlands, and Niti Surgical Solutions Ltd, Israel, research support and travel grants from Janssen-Cilag BV and Astra Zeneca BV, The Netherlands, research support from Tramedico BV, The Netherlands and Life Support Technology, The Netherlands, and a travel grant from Alveolus Inc, NC, USA. Y. Nir is an employee of Niti Surgical Solutions. A. Szold has a consulting/advisory/speaking arrangement with Niti Surgical Solutions Ltd, Israel. A. Bapaye has a consulting/advisory/speaking arrangement with Niti Surgical Solutions Ltd, Israel and Medigus Ltd., Israel. S. Lelcuk has a consulting/advisory/speaking arrangement with Niti Surgical Solutions Ltd, Israel. All other authors disclosed no financial relationships relevant to this publication. |
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| If you would like to chat with an author of this article, you may contact him at kopelmand@bezeqint.net. |
Vol 70 - N° 6
P. 1146-1157 - dicembre 2009 Ritorno al numero
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