Functional and comparative evaluation of flexible monopolar endoscopic scissors.

BACKGROUND

The continued success of natural orifice translumenal endoscopic procedures requires reliable, accurate tissue dissection and suture cutting. This study aimed to evaluate a flexible endoscopic scissors prototype.

METHODS

An acute study of two domestic swine was conducted. Laparoscopic access provided an overview and allowed comparison of the flexible endoscopic scissors with laparoscopic shears. The endoscopic cautery-compatible scissors consists of cutting blades with a flexible wire catheter assembly (outer diameter, 3.1 mm) for use within a therapeutic endoscopic channel. A dual-channel colonoscope was advanced through a gastrotomy created for peritoneal access. With the aide of a grasping forceps, multiple peritoneal biopsies were obtained using the endoscopic scissors. Cautery (Monopolar 18-30 W) then was attached to the scissors, and gallbladder dissection proceeded. The device then was used to perform a small bowel enterotomy. A timed comparison of this function with laparoscopic enterotomy was made. Finally, 3-0 Polyglactin 910 suture was cut using the endoscopic scissors.

RESULTS

Peritoneal biopsies 2 cm(2) in size were obtained from multiple abdominal locations and endoscopic positions, including the retroflexed position. The scissors cut effectively and accurately. Cutting performance was enhanced with parallel countertraction provided by grasping forceps passed through the second endoscopic channel. The use of cautery with the scissors controlled small vessels (2-3 mm) and permitted partial dissection of the gallbladder from the hepatic bed. Small bowel enterotomy sufficiently large for stapler passage was created in 4 min and 54 s. Laparoscopically, this was completed in 1 min and 22 s. Suture was successfully cut at the first attempt in a controlled, reproducible fashion.

CONCLUSIONS

Controlled tissue biopsy, dissection, enterotomy creation, and suture cutting can be performed with this endoscopic scissors. Endoscopic tissue dissection and enterotomy creation was completed effectively but less efficiently than with laparoscopy primarily due to parallel device use imposed by the dual-channel endoscope.