Testing new semiflexible instrument on biosynthetic model developed for transgastric surgery

Szülőkategória: KUTATÁSI TÉMÁK
10. 01. 09
Módosítás: 01 december 2016

P.Lukovich P.Váradi G. Zsirka A.K.Huba A. Kecskédi B. Kupcsulik P.Tari K

15th United European Gastroenterology Week (UEGW) in Paris, France 27-29 October 2007

Endoscopy 2007; 39 (Suppl I) A353

1 1st Department of Surgery, Semmelweis University, 2 Department of Mechatronics, Optics and Instrumentation Technology, Budapest University of Technology, Budapest, Hungary


INTRODUCTION: The Natural Orifice Transluminal Endoscopic Surgery (NOTES) raises several problems and technical questions, which are still waiting for solution. It is undecided yet, which cavernous organ is the most suited for managing the flexible endoscope through into the abdominal cavity. There are transvaginal, transcolonic, transvesical and transgastric procedures in the literature. Prevoiusly we performed transgastric gastro-jejunostomy, cholecystectomy and tubal ligation on biosynthetic model. For the experiments only traditional endoscopic instruments of the everyday practice were used. According to our experiences, the endoscope in retroversion, the flexible instruments guided through the working channel even in straight stand were unable to carry out safe operations.

AIMS & METHODS: The goal of our research is to work out such alterations of the new method that could raise the efficacy of the procedures. On the grounds of the literature, our experimental transgastric interventions and experiences with laparoscopic surgery we worked out a new technique different from the methods applied before. The most important alteration is the separation of the camera and operating instruments. If the endoscope would fill up the only role of the source of light and the camera, the operation area would be reviewed from more aspects and the working channel would not limit the size of devices. Co-operating with the Department of Mechatronics, Optics and Instrumentation Technology of the Budapest University of Technology a new instrument was designed. which is able to get the position of 190-degree retroversion and guided through a gastric incision capable for the operation of any abdominal organ. It is able to reach every point of the abdominal cavity by 360-degree rotation around its axle, pulling out or pushing in through the incision. We examined traditional grasper, guided through working channel and the new device; the power of constriction, the power of dissection and the degree of deviation for lateral traction were measured, even in straight stand and retroversion as well. The results were compared to the power of laparoscopic instruments, too.

RESULTS: The new developed instruments were 5-6 times stronger as the flexible grasper guided through the working channel, which is nearly similar to the power of laparoscopic ones.

CONCLUSION: The new method (separation of optics and operating instruments) not even solves one of the biggest problems (weakness of the instruments), but it owns many other advantages. Taking it into practice could raise the efficacy of transgastric endoscopic interventions.