Meireles O R, Kantsevoy S V, Assumpcao L R, Magno P, Dray X, Giday S A, Kalloo A N, Hanly E J, Marohn M R
Department of Surgery, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Halsted 608, Baltimore, MD 21287, USA.
Surg Endosc. 2008 Jul;22(7):1609-13. doi: 10.1007/s00464-008-9750-1. Epub 2008 Apr 10.
Reliable closure of the translumenal incision is one of the main challenges facing natural orifice translumenal endoscopic surgery (NOTES). This study aimed to evaluate the use of an automated flexible stapling device (SurgASSIST) for closure of the gastrotomy incision in a porcine model.
A double-channel gastroscope was advanced into the stomach. A gastric wall incision was made, and the endoscope was advanced into the peritoneal cavity. After peritoneoscopy, the endoscope was withdrawn into the stomach. The SurgASSIST stapler was advanced orally into the stomach. The gastrotomy edges were positioned between the opened stapler arms using two endoscopic grasping forceps. Stapler loads with and without a cutting blade were used for gastric closure. After firing of the stapler to close the gastric wall incision, x-ray with contrast was performed to assess for gastric leakage. At the end of the procedure, the animals were killed for a study of closure adequacy.
Four acute animal experiments were performed. The delivery and positioning of the stapler were achieved, with technical difficulties mostly due to a short working length (60 cm) of the device. Firing of the staple delivered four rows of staples. Postmortem examination of pig 1 (when a cutting blade was used) demonstrated full-thickness closure of the gastric wall incision, but the cutting blade caused a transmural hole right at the end of the staple line. For this reason, we stopped using stapler loads with a cutting blade. In the three remaining animals (pigs 2-4), we were able to achieve a full-thickness closure of the gastric wall incision without any complications.
The flexible stapling device may provide a simple and reliable technique for lumenal closure after NOTES procedures. Further survival studies are currently under way to evaluate the long-term efficacy of gastric closure with the stapler after intraperitoneal interventions.
经自然腔道内镜手术（NOTES）面临的主要挑战之一是可靠地封闭经腔切口。本研究旨在评估在猪模型中使用自动柔性吻合器（SurgASSIST）封闭胃切开切口的效果。
将双通道胃镜推进到胃内。制作胃壁切口，然后将内镜推进到腹腔。腹腔镜检查后，将内镜撤回胃内。将SurgASSIST吻合器经口推进到胃内。使用两把内镜抓钳将胃切开边缘置于打开的吻合器臂之间。使用带和不带切割刀片的吻合器钉仓进行胃闭合操作。吻合器击发以封闭胃壁切口后，进行造影X线检查以评估胃漏情况。在手术结束时，处死动物以研究闭合的充分性。
进行了四项急性动物实验。吻合器的递送和定位得以实现，技术困难主要源于该装置较短的工作长度（60厘米）。击发吻合器打出了四排吻合钉。对猪1（使用切割刀片时）的尸检显示胃壁切口全层闭合，但切割刀片在钉线末端造成了一个贯穿壁层的孔。因此，我们停止使用带切割刀片的吻合器钉仓。在其余三只动物（猪2 - 4）中，我们成功实现了胃壁切口的全层闭合，且无任何并发症。
柔性吻合器可为NOTES手术后的腔道闭合提供一种简单可靠的技术。目前正在进行进一步的生存研究，以评估腹腔内干预后使用该吻合器进行胃闭合的长期疗效。
