Transvaginal cholecystectomy by using a prototype flexible clip applier - 24/08/11
Reprint requests: Klaus Thaler, MD, FACS, Department of General Surgery, University of Missouri, One Hospital Drive, Columbia, MO 65212Riassunto |
Background |
Currently, no endoscopic clips have been proven to be effective in ligating the cystic duct in natural orifice transluminal endoscopic surgery (NOTES) hybrid cholecystectomy.
Objective |
To determine the safety and feasibility of a prototype endoscopic flexible clip applier, which is the only flexible device that deploys a zero-gap clip.
Design |
Pilot study in a survival porcine model. Necropsy was performed at 2 weeks postprocedure.
Setting |
University of Missouri animal laboratory, Columbia, Missouri.
Intervention |
Transvaginal cholecystectomy was performed on 6 survival pigs using the NOTES Toolbox 1.0.
Main Outcome Measurements |
Safety and feasibility of the described instrument. Investigators were asked to fill out a standardized, blinded questionnaire on the ease of use and functionality of the flexible clip applier.
Results |
Clipping of the cystic duct was achieved with the flexible clip applier in all 6 pigs. The mean time for completion of clipping of the cystic duct was 9 minutes. Multiple attempts were required to successfully fire the clip in 2 of 6 pigs. We were unable to visualize the tip of the clip before deployment. Difficulty releasing the clip from the applier once fired and challenges in clip loading were encountered. The clips were visualized in place at necropsy, with no bile leakage, evidence of infection, or injury to surrounding structures seen in any cases.
Limitations |
Preclinical animal model.
Conclusion |
The prototype flexible clip applier showed adequate safety and was feasible in clipping the cystic duct in all animals. Design efforts to improve clip visualization, loading, and release are underway.
Il testo completo di questo articolo è disponibile in PDF.Abbreviations : EES, IQR, NOTES
Mappa
| DISCLOSURE: B Miedema and K Thaler disclosed research support from and consulting relationships with Ethicon Endo-Surgery. All other authors disclosed no financial relationships relevant to this publication. |
Vol 72 - N° 2
P. 351-357 - agosto 2010 Ritorno al numero
Articolo precedente
- Gastric wall healing after NOTES procedures: closure with endoscopic clips provides superior histological outcome compared with threaded tags closure
- Xavier Dray, Devi M. Krishnamurty, Gianfranko Donatelli, Kathleen L. Gabrielson, Ronald J. Wroblewski, Eun J. Shin, Samuel A. Giday, Jonathan M. Buscaglia, Laurie J. Pipitone, Michael R. Marohn, Anthony N. Kalloo, Sergey V. Kantsevoy
- EUS-guided Nd:YAG laser ablation of normal pancreatic tissue: a pilot study in a pig model
- Francesco Di Matteo, Margareth Martino, Roberta Rea, Monica Pandolfi, Carla Rabitti, Grazia Maria Paola Masselli, Sergio Silvestri, Claudio Maurizio Pacella, Enrico Papini, Francesco Panzera, Sergio Valeri, Roberto Coppola, Guido Costamagna
Benvenuto su EM|consulte, il riferimento dei professionisti della salute.
L'accesso al testo integrale di questo articolo richiede un abbonamento.
Già abbonato a @@106933@@ rivista ?