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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

Double-armed Bar Suturing System (DBSS). (A) The DBSS can be attached in a single operation by attaching the hood part to the tip of a multipurpose endoscope with one channel. (B, C) Various types of the DBSS, such as the Mini-DBSS, the Middle-DBSS, and the Normal-DBSS, can be selected according to the size of the perforation opening.
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f4-gnl-09-590: Double-armed Bar Suturing System (DBSS). (A) The DBSS can be attached in a single operation by attaching the hood part to the tip of a multipurpose endoscope with one channel. (B, C) Various types of the DBSS, such as the Mini-DBSS, the Middle-DBSS, and the Normal-DBSS, can be selected according to the size of the perforation opening.

Mentions: Although the Overstitch System is an innovative flexible endoscopic full-thickness suturing device with suturing threads, its anteriorly-directed suture needle may cause injury and suturing of adjacent organs when the full-thickness stomach wall is sutured. The OTSC can be attached to a normal multipurpose endoscope and be used with relative ease. However, it has a problem with suture misfire because it is a clip-type suturing device, meaning it cannot be turned back once it is released. Furthermore, it is mechanical and does not use any suturing thread, which causes gaps in the OTSC intervals, making it difficult to complete full-thickness suturing. Thus, there remains no flexible endoscopic full-thickness suturing device that is economical, simple, easily operated, and can be attached to multipurpose endoscopes. Mori et al.40 developed a flexible endoscopic full-thickness suturing device which provides suturing performance comparable to surgical hand-suturing techniques. For the Double-armed Bar Suturing System (DBSS), as shown in Fig. 4A and B, only a hood is attached to the tip of the multipurpose, one-channel endoscope, and the opening of the forceps is not used. Thus, opening of the forceps may yet have various uses for the DBSS (Fig. 4A). Based on the size of the perforation opening, various prototypes, such as Mini-DBSS, Middle-DBSS, and Normal-DBSS, can be used (Fig. 4B and C).


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)

Double-armed Bar Suturing System (DBSS). (A) The DBSS can be attached in a single operation by attaching the hood part to the tip of a multipurpose endoscope with one channel. (B, C) Various types of the DBSS, such as the Mini-DBSS, the Middle-DBSS, and the Normal-DBSS, can be selected according to the size of the perforation opening.
© Copyright Policy
Related In: Results  -  Collection

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

f4-gnl-09-590: Double-armed Bar Suturing System (DBSS). (A) The DBSS can be attached in a single operation by attaching the hood part to the tip of a multipurpose endoscope with one channel. (B, C) Various types of the DBSS, such as the Mini-DBSS, the Middle-DBSS, and the Normal-DBSS, can be selected according to the size of the perforation opening.
Mentions: Although the Overstitch System is an innovative flexible endoscopic full-thickness suturing device with suturing threads, its anteriorly-directed suture needle may cause injury and suturing of adjacent organs when the full-thickness stomach wall is sutured. The OTSC can be attached to a normal multipurpose endoscope and be used with relative ease. However, it has a problem with suture misfire because it is a clip-type suturing device, meaning it cannot be turned back once it is released. Furthermore, it is mechanical and does not use any suturing thread, which causes gaps in the OTSC intervals, making it difficult to complete full-thickness suturing. Thus, there remains no flexible endoscopic full-thickness suturing device that is economical, simple, easily operated, and can be attached to multipurpose endoscopes. Mori et al.40 developed a flexible endoscopic full-thickness suturing device which provides suturing performance comparable to surgical hand-suturing techniques. For the Double-armed Bar Suturing System (DBSS), as shown in Fig. 4A and B, only a hood is attached to the tip of the multipurpose, one-channel endoscope, and the opening of the forceps is not used. Thus, opening of the forceps may yet have various uses for the DBSS (Fig. 4A). Based on the size of the perforation opening, various prototypes, such as Mini-DBSS, Middle-DBSS, and Normal-DBSS, can be used (Fig. 4B and C).

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