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Review of Pure Endoscopic Full-Thickness Resection of the Upper Gastrointestinal Tract.

Mori H, Kobara H, Nishiyama N, Fujihara S, Masaki T - Gut Liver (2015)

Bottom Line: It is expected that gastroenterological endoscopists will use this surgery if device development is advanced.This extremely minimally invasive surgery would have an immeasurable impact with regard to mitigating the burden on patients and reducing healthcare costs.Development of a new surgical method using a multi-purpose flexible endoscope is therefore considered a socially urgent issue.

View Article: PubMed Central - PubMed

Affiliation: Department of Gastroenterology and Neurology, Kagawa University, Kita, Japan.

ABSTRACT
Natural-orifice transluminal endoscopic surgery (NOTES) using flexible endoscopy has attracted attention as a minimally invasive surgical method that does not cause an operative wound on the body surface. However, minimizing the number of devices involved in endoscopic, compared to laparoscopic, surgeries has remained a challenge, causing endoscopic surgeries to gradually be phased out of use. If a flexible endoscopic full-thickness suturing device and a counter-traction device were developed to expand the surgical field for gastrointestinal-tract collapse, then endoscopic full-thickness resection using NOTES, which is seen as an extension of endoscopic submucosal dissection for full-thickness excision of tumors involving the gastrointestinal-tract wall, might become an extremely minimally invasive surgical method that could be used to resect only full-thickness lesions approached by the shortest distance via the mouth. It is expected that gastroenterological endoscopists will use this surgery if device development is advanced. This extremely minimally invasive surgery would have an immeasurable impact with regard to mitigating the burden on patients and reducing healthcare costs. Development of a new surgical method using a multi-purpose flexible endoscope is therefore considered a socially urgent issue.

No MeSH data available.


Related in: MedlinePlus

Overstitch System and Over-The-Scope-Clip (OTSC). (A) Although the Overstitch System is an innovative flexible endoscopic full-thickness suturing device with suturing threads, because of its anteriorly directed suture needle, caution should be exercised so as not to cause injury to adjacent organs. Additionally, the OTSC requires two-channel scopes. (B) The OTSC can be attached to a normal multipurpose endoscope and can be used relatively easily. Because it is a clip-type suturing device, which means that it cannot turn back once it is released, caution should be exercised to avoid suture misfire.
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f3-gnl-09-590: Overstitch System and Over-The-Scope-Clip (OTSC). (A) Although the Overstitch System is an innovative flexible endoscopic full-thickness suturing device with suturing threads, because of its anteriorly directed suture needle, caution should be exercised so as not to cause injury to adjacent organs. Additionally, the OTSC requires two-channel scopes. (B) The OTSC can be attached to a normal multipurpose endoscope and can be used relatively easily. Because it is a clip-type suturing device, which means that it cannot turn back once it is released, caution should be exercised to avoid suture misfire.

Mentions: For full-thickness suturing devices, the leak test has been used to evaluate sutures. Liu et al.36 prepared a 2-cm linear incision with 51 ex vivo porcine stomach models and evaluated technical difficulties of closure using Eagle Claw VIII and endoclips, as follows: bursting pressures were 56 mm Hg (range, 35 to 110 mm Hg) for Eagle Claw VIII, 19 mm Hg (range, 9 to 65 mm Hg) for endoclips, and 78 mm Hg (range, 63 to 110 mm Hg) for surgical suturing; eagle Claw VIII could withstand a higher endoluminal pneumatic bursting pressure than endoclips. Sun et al.37 measured the leakage pressures of endoclip, omentoplasty, over-the-scope-clip (OTSC), and hand-suturing and reported that suturing with OTSC and hand-suturing showed significantly higher suturing performance, as follows: the endoclip and omentoplasty groups generated similar leakage pressures (34.5±2.6 mm Hg vs 42.2±4.1 mm Hg, p>0.05), both lower than OTSC and hand-suturing groups (81.5±2.1 mm Hg and 87.0±3.0 mm Hg, respectively, p<0.001). The only flexible endoscopic full-thickness suturing device with suturing threads that is currently available commercially (in the world) is the Overstitch System (Apollo Endosurgery, Austin, TX, USA) (Fig. 3A).38 A clip-type full-thickness suturing device, the OTSC (Ovesco Endoscopy GmbH, Tüebingen, Germany), is on the market (Fig. 3B).39 However, no full-thickness suturing device has been developed that can be easily attached to a common multipurpose flexible endoscope with one channel, and the Overstitch System requires two channel scopes.


Review of Pure Endoscopic Full-Thickness Resection of the Upper Gastrointestinal Tract.

Mori H, Kobara H, Nishiyama N, Fujihara S, Masaki T - Gut Liver (2015)

Overstitch System and Over-The-Scope-Clip (OTSC). (A) Although the Overstitch System is an innovative flexible endoscopic full-thickness suturing device with suturing threads, because of its anteriorly directed suture needle, caution should be exercised so as not to cause injury to adjacent organs. Additionally, the OTSC requires two-channel scopes. (B) The OTSC can be attached to a normal multipurpose endoscope and can be used relatively easily. Because it is a clip-type suturing device, which means that it cannot turn back once it is released, caution should be exercised to avoid suture misfire.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4562775&req=5

f3-gnl-09-590: Overstitch System and Over-The-Scope-Clip (OTSC). (A) Although the Overstitch System is an innovative flexible endoscopic full-thickness suturing device with suturing threads, because of its anteriorly directed suture needle, caution should be exercised so as not to cause injury to adjacent organs. Additionally, the OTSC requires two-channel scopes. (B) The OTSC can be attached to a normal multipurpose endoscope and can be used relatively easily. Because it is a clip-type suturing device, which means that it cannot turn back once it is released, caution should be exercised to avoid suture misfire.
Mentions: For full-thickness suturing devices, the leak test has been used to evaluate sutures. Liu et al.36 prepared a 2-cm linear incision with 51 ex vivo porcine stomach models and evaluated technical difficulties of closure using Eagle Claw VIII and endoclips, as follows: bursting pressures were 56 mm Hg (range, 35 to 110 mm Hg) for Eagle Claw VIII, 19 mm Hg (range, 9 to 65 mm Hg) for endoclips, and 78 mm Hg (range, 63 to 110 mm Hg) for surgical suturing; eagle Claw VIII could withstand a higher endoluminal pneumatic bursting pressure than endoclips. Sun et al.37 measured the leakage pressures of endoclip, omentoplasty, over-the-scope-clip (OTSC), and hand-suturing and reported that suturing with OTSC and hand-suturing showed significantly higher suturing performance, as follows: the endoclip and omentoplasty groups generated similar leakage pressures (34.5±2.6 mm Hg vs 42.2±4.1 mm Hg, p>0.05), both lower than OTSC and hand-suturing groups (81.5±2.1 mm Hg and 87.0±3.0 mm Hg, respectively, p<0.001). The only flexible endoscopic full-thickness suturing device with suturing threads that is currently available commercially (in the world) is the Overstitch System (Apollo Endosurgery, Austin, TX, USA) (Fig. 3A).38 A clip-type full-thickness suturing device, the OTSC (Ovesco Endoscopy GmbH, Tüebingen, Germany), is on the market (Fig. 3B).39 However, no full-thickness suturing device has been developed that can be easily attached to a common multipurpose flexible endoscope with one channel, and the Overstitch System requires two channel scopes.

Bottom Line: It is expected that gastroenterological endoscopists will use this surgery if device development is advanced.This extremely minimally invasive surgery would have an immeasurable impact with regard to mitigating the burden on patients and reducing healthcare costs.Development of a new surgical method using a multi-purpose flexible endoscope is therefore considered a socially urgent issue.

View Article: PubMed Central - PubMed

Affiliation: Department of Gastroenterology and Neurology, Kagawa University, Kita, Japan.

ABSTRACT
Natural-orifice transluminal endoscopic surgery (NOTES) using flexible endoscopy has attracted attention as a minimally invasive surgical method that does not cause an operative wound on the body surface. However, minimizing the number of devices involved in endoscopic, compared to laparoscopic, surgeries has remained a challenge, causing endoscopic surgeries to gradually be phased out of use. If a flexible endoscopic full-thickness suturing device and a counter-traction device were developed to expand the surgical field for gastrointestinal-tract collapse, then endoscopic full-thickness resection using NOTES, which is seen as an extension of endoscopic submucosal dissection for full-thickness excision of tumors involving the gastrointestinal-tract wall, might become an extremely minimally invasive surgical method that could be used to resect only full-thickness lesions approached by the shortest distance via the mouth. It is expected that gastroenterological endoscopists will use this surgery if device development is advanced. This extremely minimally invasive surgery would have an immeasurable impact with regard to mitigating the burden on patients and reducing healthcare costs. Development of a new surgical method using a multi-purpose flexible endoscope is therefore considered a socially urgent issue.

No MeSH data available.


Related in: MedlinePlus