Mellinger John D, MacFadyen Bruce V, Kozarek Richard A, Soper Nathaniel D, Birkett Desmond H, Swanstrom Lee L
Department of Surgery, Medical College of Georgia, Augusta, GA, USA.
Surg Endosc. 2007 Jun;21(6):1002-5. doi: 10.1007/s00464-007-9309-6. Epub 2007 Apr 13.
Current developments in intraluminal and transluminal natural orifice surgery are limited by issues of access, tissue manipulation, and secure tissue approximation/closure. This report describes an initial laboratory experience with a novel tissue approximation and suturing device. The device is deployed via a previously described platform and is 6 mm in diameter. Desirable qualities of this tissue approximation/closure device include robust tissue grasping, minimal tissue trauma, fully visualized anchor placement via off-axis needle and anchor deployment, full reloadability without instrument withdrawal, single-operator operating capability, torque-stable manipulability, and operator-controlled tension setting of tissue anchor pairs.
The device was trialed in performing several maneuvers in porcine or canine models. The features of the system allowed bimanual tissue manipulation, full-thickness tissue approximation and plication, and secure closure of an ex vivo gastrotomy hole similar to that used during transluminal surgical interventions.
This device appears to offer promise in achieving more complex endoluminal and potentially transluminal tasks, including secure suture closure of tissue defects and access holes. As such, devices of this type may prove useful in addressing some of the identified barriers to further development of natural orifice surgical intervention. Further investigation of the qualities and capabilities of this device in these settings is warranted.
腔内和经腔自然腔道手术的当前发展受到通路、组织操作以及可靠的组织对合/闭合等问题的限制。本报告描述了使用一种新型组织对合和缝合装置的初步实验室经验。该装置通过先前描述的平台进行部署，直径为6毫米。这种组织对合/闭合装置的理想特性包括牢固的组织抓取、最小的组织创伤、通过偏轴针和锚定器部署实现完全可视化的锚定器放置、无需撤出器械即可完全重新装填、单操作者操作能力、扭矩稳定的可操作性以及操作者控制组织锚定器对的张力设置。
该装置在猪或犬模型中进行了多项操作试验。该系统的特性允许双手进行组织操作、全层组织对合和折叠，以及类似于经腔手术干预期间使用的体外胃切开孔的可靠闭合。
该装置在完成更复杂的腔内和潜在的经腔任务方面似乎具有前景，包括组织缺损和通路孔的可靠缝合闭合。因此，这类装置可能被证明有助于解决自然腔道手术干预进一步发展中确定的一些障碍。有必要进一步研究该装置在这些情况下的特性和能力。
