Early experience with a novel dedicated port system for intra-gastric surgery

Renato V Soares, MD1, Lee L Swanstrom, MD1, Mark Molos, MD2, Noriaki Kameyama, PhD1, Seong-Ho Kong, MD1, Poornima Donepudi, MD1, Pietro Riva, MD1, Galyna Shabat, MD1, Jaques Marescaux, MD3. 1IHU-Strasbourg, 2endoTAGS, 3IRCAD

1. Objective of the technology or device- A novel trocar that is placed endoscopically to facilitate intra-gastric laparoscopic and endoscopic surgeries.

2. Description of the technology and method of its use or application – Intra-gastric laparoscopic and hybrid laparoscopic surgeries have been described since the early 1990s, insertion of standard laparoscopic trocars into the stomach, enabling hybrid intra-gastric surgery, is often time-consuming and cumbersome. In addition, standard trocars frequently are not airtight and can dislodge. We describe a novel port system designed to enable intra-gastric surgery. The system comprises 5 and 12mm ports inserted endoscopically using a technique similar to a percutaneous endoscopic gastrostomy (PEG). Endoscopic placement also allows accurate selection of the optimal position for the ports. After port placement, laparoscopic insuflators and laparoscopic instruments can be used to perform various intra-gastric procedures.

3. Preliminary results if available- In a series of acute swine experiments we inserted three intra-gastric ports and performed multiple laparoscopic and hybrid procedures: hybrid ESD, endoluminal stapled pyloroplasty, endoluminal fundoplication, trans-gastric duodenal stent placement and fixation, trans-gastric retroperitoneal exploration and a full thickness gastric resection. Average time to place ports was 5 minutes each. There were no premature dislodgement or problems maintaining gastric insufflation. The small gastric defects were closed with full-thickness sutures using a laparoscopic suture-passer.

4. Conclusions / future directions- The system allowed safe and rapid insertion of secure intra-gastric ports, successful completion of the procedures and safe removal and closure of the gastric wall. Further testing of the device will explore additional laparoscopic and hybrid intra-gastric procedures facilitated by these new trocars.

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