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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

Mechanical Counter-Traction System (MCTS). (A) The MCTS is housed inside an overtube with a 20-mm diameter. (B) When the overtube is pulled, eight expansion arms widen the collapsing stomach wall. (C) In an in vivo experiment in a dog, sufficient expansion of the surgical field allowed endoscopic full-thickness resection to be accomplished without insufflation.
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f6-gnl-09-590: Mechanical Counter-Traction System (MCTS). (A) The MCTS is housed inside an overtube with a 20-mm diameter. (B) When the overtube is pulled, eight expansion arms widen the collapsing stomach wall. (C) In an in vivo experiment in a dog, sufficient expansion of the surgical field allowed endoscopic full-thickness resection to be accomplished without insufflation.

Mentions: We developed and reported various prototypes of counter traction devices.46,47Fig. 6A and B show the Mechanical Counter Traction System (MCTS) that is housed inside an overtube. Fig. 6C shows EFTR of a 40-mm-diameter virtual lesion in resected swine stomach using a prototype of MCTS. Stopping insufflation of the endoscope, the control part at hand was pushed out, the collapsing stomach wall was extended with eight expansion arms, and the full-thickness stomach wall of the site (40-mm-diameter virtual tumor) was resected. However, there were limitations in this overtube-type MCTS regarding compliance with the complicated endoscopic operation, such as the reversing operation. Thus, we intentionally placed balloons, which expand on one side on the tip of the endoscope body, so that they would interfere with each other, to avoid blocking the visual endoscopic field. Fig. 7 is a balloon-type counter traction device that uses a large number of one-side expanded balloons. This Balloon Arm-Mechanical Counter Traction System (BA-MCTS) is attached to the tip of the endoscope (Fig. 7A) and enables expansion of the surgical field, such as the reversing operation of the entire stomach without insufflation. Fig. 7B shows pure EFTR in an excised porcine stomach.


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)

Mechanical Counter-Traction System (MCTS). (A) The MCTS is housed inside an overtube with a 20-mm diameter. (B) When the overtube is pulled, eight expansion arms widen the collapsing stomach wall. (C) In an in vivo experiment in a dog, sufficient expansion of the surgical field allowed endoscopic full-thickness resection to be accomplished without insufflation.
© Copyright Policy
Related In: Results  -  Collection

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

f6-gnl-09-590: Mechanical Counter-Traction System (MCTS). (A) The MCTS is housed inside an overtube with a 20-mm diameter. (B) When the overtube is pulled, eight expansion arms widen the collapsing stomach wall. (C) In an in vivo experiment in a dog, sufficient expansion of the surgical field allowed endoscopic full-thickness resection to be accomplished without insufflation.
Mentions: We developed and reported various prototypes of counter traction devices.46,47Fig. 6A and B show the Mechanical Counter Traction System (MCTS) that is housed inside an overtube. Fig. 6C shows EFTR of a 40-mm-diameter virtual lesion in resected swine stomach using a prototype of MCTS. Stopping insufflation of the endoscope, the control part at hand was pushed out, the collapsing stomach wall was extended with eight expansion arms, and the full-thickness stomach wall of the site (40-mm-diameter virtual tumor) was resected. However, there were limitations in this overtube-type MCTS regarding compliance with the complicated endoscopic operation, such as the reversing operation. Thus, we intentionally placed balloons, which expand on one side on the tip of the endoscope body, so that they would interfere with each other, to avoid blocking the visual endoscopic field. Fig. 7 is a balloon-type counter traction device that uses a large number of one-side expanded balloons. This Balloon Arm-Mechanical Counter Traction System (BA-MCTS) is attached to the tip of the endoscope (Fig. 7A) and enables expansion of the surgical field, such as the reversing operation of the entire stomach without insufflation. Fig. 7B shows pure EFTR in an excised porcine stomach.

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