A new stapler-based full-thickness transgastric access closure: Results from an animal pilot trial

P. Magno; S. A. Giday; X. Dray; S. S. Chung; P. B. Cotton; C. J. Gostout; R. H. Hawes; A. N. Kalloo; P. J. Pasricha; J. J. White; L. Assumpcao; M. R. Marohn; K. L. Gabrielson; S. V. Kantsevoy

doi:10.1055/s-2007-966896

A new stapler-based full-thickness transgastric access closure: Results from an animal pilot trial

P. Magno, S. A. Giday, X. Dray, S. S. Chung, P. B. Cotton, C. J. Gostout, R. H. Hawes, A. N. Kalloo, P. J. Pasricha, J. J. White, L. Assumpcao, M. R. Marohn, K. L. Gabrielson, S. V. Kantsevoy

School of Medicine

Research output: Contribution to journal › Article › peer-review

76 Scopus citations

Abstract

Background and study aims: Reliable closure of the translumenal incision is the crucial step for natural orifice translumenal endoscopic surgery (NOTES) procedures. The aim of this study was to evaluate the feasibility and effectiveness of transgastric access closure with a flexible stapling device in a porcine survival model. Patients and methods: We carried out four experiments (two sterile and two nonsterile) on 50 kg pigs. The endoscope was passed through a gastrotomy made with a needle knife and an 18-mm controlled radial expansion dilating balloon. After peritoneoscopy, a flexible linear stapling device (NOLC60, Power Medical Interventions®, Langhorne, Pennsylvania, USA) was perorally advanced over a guide wire into the stomach, positioned under endoscopic guidance, and opened to include the site of gastrotomy between its two arms; four rows of staples were fired. One animal was sacrificed 24 hours after the procedure (progression of pre-existing pneumonia). The remaining animals were survived for 1 week and then underwent repeat endoscopy and postmortem examination. Results: Peroral delivery and positioning of the stapling device involved some technical difficulties, mostly due to the short length (60 cm) of the stapling device. The stapler provided complete leak-resistant gastric closure in all pigs. None of the surviving animals had any clinical signs of infection. Necropsy demonstrated an intact staple line with full-thickness healing of the gastrotomy in all animals. Histologic examination confirmed healing, but also revealed intramural micro-abscesses within the gastric wall after nonsterile procedure. Conclusions: Gastrotomy closure with a perorally delivered flexible stapling device created a leak-resistant transmural line of staples followed by full-thickness healing of the gastric wall incision. Increasing the length of the instrument and adding device articulation will further facilitate its use for NOTES procedures.

Original language	English (US)
Pages (from-to)	876-880
Number of pages	5
Journal	Endoscopy
Volume	39
Issue number	10
DOIs	https://doi.org/10.1055/s-2007-966896
State	Published - Oct 2007

ASJC Scopus subject areas

Gastroenterology

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Magno, P., Giday, S. A., Dray, X., Chung, S. S., Cotton, P. B., Gostout, C. J., Hawes, R. H., Kalloo, A. N., Pasricha, P. J., White, J. J., Assumpcao, L., Marohn, M. R., Gabrielson, K. L., & Kantsevoy, S. V. (2007). A new stapler-based full-thickness transgastric access closure: Results from an animal pilot trial. Endoscopy, 39(10), 876-880. https://doi.org/10.1055/s-2007-966896

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title = "A new stapler-based full-thickness transgastric access closure: Results from an animal pilot trial",

abstract = "Background and study aims: Reliable closure of the translumenal incision is the crucial step for natural orifice translumenal endoscopic surgery (NOTES) procedures. The aim of this study was to evaluate the feasibility and effectiveness of transgastric access closure with a flexible stapling device in a porcine survival model. Patients and methods: We carried out four experiments (two sterile and two nonsterile) on 50 kg pigs. The endoscope was passed through a gastrotomy made with a needle knife and an 18-mm controlled radial expansion dilating balloon. After peritoneoscopy, a flexible linear stapling device (NOLC60, Power Medical Interventions{\textregistered}, Langhorne, Pennsylvania, USA) was perorally advanced over a guide wire into the stomach, positioned under endoscopic guidance, and opened to include the site of gastrotomy between its two arms; four rows of staples were fired. One animal was sacrificed 24 hours after the procedure (progression of pre-existing pneumonia). The remaining animals were survived for 1 week and then underwent repeat endoscopy and postmortem examination. Results: Peroral delivery and positioning of the stapling device involved some technical difficulties, mostly due to the short length (60 cm) of the stapling device. The stapler provided complete leak-resistant gastric closure in all pigs. None of the surviving animals had any clinical signs of infection. Necropsy demonstrated an intact staple line with full-thickness healing of the gastrotomy in all animals. Histologic examination confirmed healing, but also revealed intramural micro-abscesses within the gastric wall after nonsterile procedure. Conclusions: Gastrotomy closure with a perorally delivered flexible stapling device created a leak-resistant transmural line of staples followed by full-thickness healing of the gastric wall incision. Increasing the length of the instrument and adding device articulation will further facilitate its use for NOTES procedures.",

author = "P. Magno and Giday, {S. A.} and X. Dray and Chung, {S. S.} and Cotton, {P. B.} and Gostout, {C. J.} and Hawes, {R. H.} and Kalloo, {A. N.} and Pasricha, {P. J.} and White, {J. J.} and L. Assumpcao and Marohn, {M. R.} and Gabrielson, {K. L.} and Kantsevoy, {S. V.}",

year = "2007",

month = oct,

doi = "10.1055/s-2007-966896",

language = "English (US)",

volume = "39",

pages = "876--880",

journal = "Endoscopy",

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T1 - A new stapler-based full-thickness transgastric access closure

T2 - Results from an animal pilot trial

AU - Magno, P.

AU - Giday, S. A.

AU - Dray, X.

AU - Chung, S. S.

AU - Cotton, P. B.

AU - Gostout, C. J.

AU - Hawes, R. H.

AU - Kalloo, A. N.

AU - Pasricha, P. J.

AU - White, J. J.

AU - Assumpcao, L.

AU - Marohn, M. R.

AU - Gabrielson, K. L.

AU - Kantsevoy, S. V.

PY - 2007/10

Y1 - 2007/10

N2 - Background and study aims: Reliable closure of the translumenal incision is the crucial step for natural orifice translumenal endoscopic surgery (NOTES) procedures. The aim of this study was to evaluate the feasibility and effectiveness of transgastric access closure with a flexible stapling device in a porcine survival model. Patients and methods: We carried out four experiments (two sterile and two nonsterile) on 50 kg pigs. The endoscope was passed through a gastrotomy made with a needle knife and an 18-mm controlled radial expansion dilating balloon. After peritoneoscopy, a flexible linear stapling device (NOLC60, Power Medical Interventions®, Langhorne, Pennsylvania, USA) was perorally advanced over a guide wire into the stomach, positioned under endoscopic guidance, and opened to include the site of gastrotomy between its two arms; four rows of staples were fired. One animal was sacrificed 24 hours after the procedure (progression of pre-existing pneumonia). The remaining animals were survived for 1 week and then underwent repeat endoscopy and postmortem examination. Results: Peroral delivery and positioning of the stapling device involved some technical difficulties, mostly due to the short length (60 cm) of the stapling device. The stapler provided complete leak-resistant gastric closure in all pigs. None of the surviving animals had any clinical signs of infection. Necropsy demonstrated an intact staple line with full-thickness healing of the gastrotomy in all animals. Histologic examination confirmed healing, but also revealed intramural micro-abscesses within the gastric wall after nonsterile procedure. Conclusions: Gastrotomy closure with a perorally delivered flexible stapling device created a leak-resistant transmural line of staples followed by full-thickness healing of the gastric wall incision. Increasing the length of the instrument and adding device articulation will further facilitate its use for NOTES procedures.

AB - Background and study aims: Reliable closure of the translumenal incision is the crucial step for natural orifice translumenal endoscopic surgery (NOTES) procedures. The aim of this study was to evaluate the feasibility and effectiveness of transgastric access closure with a flexible stapling device in a porcine survival model. Patients and methods: We carried out four experiments (two sterile and two nonsterile) on 50 kg pigs. The endoscope was passed through a gastrotomy made with a needle knife and an 18-mm controlled radial expansion dilating balloon. After peritoneoscopy, a flexible linear stapling device (NOLC60, Power Medical Interventions®, Langhorne, Pennsylvania, USA) was perorally advanced over a guide wire into the stomach, positioned under endoscopic guidance, and opened to include the site of gastrotomy between its two arms; four rows of staples were fired. One animal was sacrificed 24 hours after the procedure (progression of pre-existing pneumonia). The remaining animals were survived for 1 week and then underwent repeat endoscopy and postmortem examination. Results: Peroral delivery and positioning of the stapling device involved some technical difficulties, mostly due to the short length (60 cm) of the stapling device. The stapler provided complete leak-resistant gastric closure in all pigs. None of the surviving animals had any clinical signs of infection. Necropsy demonstrated an intact staple line with full-thickness healing of the gastrotomy in all animals. Histologic examination confirmed healing, but also revealed intramural micro-abscesses within the gastric wall after nonsterile procedure. Conclusions: Gastrotomy closure with a perorally delivered flexible stapling device created a leak-resistant transmural line of staples followed by full-thickness healing of the gastric wall incision. Increasing the length of the instrument and adding device articulation will further facilitate its use for NOTES procedures.

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A new stapler-based full-thickness transgastric access closure: Results from an animal pilot trial

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