SAGES » Abstracts http://www.sages.org Society of American Gastrointestinal and Endoscopic Surgeons Mon, 28 Jul 2014 13:16:16 +0000 en-US hourly 1 http://wordpress.org/?v=3.9.1 Non Randomised Comparative Study Comparing Conventional versus Single Access Laparoscopic (SAL) Right Hemicolectomyhttp://www.sages.org/meetings/annual-meeting/abstracts-archive/non-randomised-comparative-study-comparing-conventional-versus-single-access-laparoscopic-sal-right-hemicolectomy/?utm_source=rss&utm_medium=rss&utm_campaign=non-randomised-comparative-study-comparing-conventional-versus-single-access-laparoscopic-sal-right-hemicolectomy http://www.sages.org/meetings/annual-meeting/abstracts-archive/non-randomised-comparative-study-comparing-conventional-versus-single-access-laparoscopic-sal-right-hemicolectomy/#respond Mon, 01 Jul 2013 17:59:58 +0000 http://www.sages.org/meetings/annual-meeting/abstracts-archive/non-randomised-comparative-study-comparing-conventional-versus-single-access-laparoscopic-sal-right-hemicolectomy/ Tikfu Gee, MBBS, MS, Kheng Wah Ong, MBBS, MS, Zubaidah Hanifa, MBBS, MS, Oo Myint Minn, MBBS, MS, Suriyana Ghani, MBBS, Qisti Fathi Nik, MBBS Universiti Putra Malaysia Conventional multi port surgery has now been accepted as safe and reliable in colorectal cancer surgery in terms of oncological clearance and patient morbidity. Recent advances have […]

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Tikfu Gee, MBBS, MS, Kheng Wah Ong, MBBS, MS, Zubaidah Hanifa, MBBS, MS, Oo Myint Minn, MBBS, MS, Suriyana Ghani, MBBS, Qisti Fathi Nik, MBBS

Universiti Putra Malaysia

Conventional multi port surgery has now been accepted as safe and reliable in colorectal cancer surgery in terms of oncological clearance and patient morbidity. Recent advances have gravitated toward using a single port or access for a right hemicolectomy. At this early stage, available data in single centres are small in number as with comparative studies between the conventional versus a single access methods. The aim of this study is to compare the conventional multi port laparoscopic surgery with single access laparoscopic surgery (SAL) for right hemicolectomy. The study was conducted in Hospital Kuala Lumpur under the Department of Surgery, Universiti Putra Malaysia. The surgeries were done by a team of 4 surgeons. All right hemicolectomy surgeries were done laparoscopically. No randomization was done. The cases collected were from January 2010 till December 2011. The first port insertion was done by a 12mm trocar optical entry method, subsequent ports were inserted under direct vision. For the single access method, a 4 cm omega shaped skin marking was done and 3 ports were used, two 5mm and a 12mm. Straight laparoscopic instruments were used as with medial to lateral dissection . The mobilized bowel was brought out via an enlarged umbilical wound protected by an Alexis wound retractor. Resection and side to side anastomosis was completed with staplers. The wound was closed in a single layer with non absorbable sutures. Skin closure was with similar sutures via an umbilicoplasty. Post operative pain control was with intravenous Tramadol. Parameters observed were operative time, post operative pain score, TMN staging, lymph node yield and number of involved nodes, involved margins and complications. A total of 21 cases were done during the study period, 3 SAL in 2010 and 8 in 2011. The mean age was 63.3 and 60.6 for conventional and SAL hemicolectomy respectively. Operative time was also similar with a mean of 166.6 minutes and 134 minutes respectively. Both were statistically insignificant. Pain score difference was statistically significant with a p value of 0.001. In regards to oncological clearance, all except 1 case was a T2 tumour, the rest of the cases was staged as T3. Nodal status ranged from N0 to N2. Lymph node yield in conventional laparoscopic surgery ranged from 8 to 50 nodes while in SAL hemicolectomy nodal yield ranged from 10 to 22 nodes. All cases had clear surgical margins. No complications were observed. With less pain patients are able to ambulate much faster thereby reducing post operative complications arising from prolonged rest in bed. However SAL has a steeper learning curve as there is a disadvantage from the lack of triangulation found in conventional techniques. More experience is needed and larger studies are required to assess the long term effects.


Session: Poster Presentation

Program Number: ETP077

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Early results of a comparative study of a novel reversible weight loss surgery vs sleeve gastrectomy for morbid obesityhttp://www.sages.org/meetings/annual-meeting/abstracts-archive/early-results-of-a-comparative-study-of-a-novel-reversible-weight-loss-surgery-vs-sleeve-gastrectomy-for-morbid-obesity/?utm_source=rss&utm_medium=rss&utm_campaign=early-results-of-a-comparative-study-of-a-novel-reversible-weight-loss-surgery-vs-sleeve-gastrectomy-for-morbid-obesity http://www.sages.org/meetings/annual-meeting/abstracts-archive/early-results-of-a-comparative-study-of-a-novel-reversible-weight-loss-surgery-vs-sleeve-gastrectomy-for-morbid-obesity/#respond Mon, 01 Jul 2013 17:59:57 +0000 http://www.sages.org/meetings/annual-meeting/abstracts-archive/early-results-of-a-comparative-study-of-a-novel-reversible-weight-loss-surgery-vs-sleeve-gastrectomy-for-morbid-obesity/ Tikfu Gee, MBBS, MS, Kheng Wah Ong, MBBS, MS, Zubaidah Hanifa, MBBS, MS, Oo Myint Minn, MBBS, MS, Suriyana Ghani, MBBS, Shu Yu Lim, MD Universiti Putra Malaysia Morbid obesity is a serious health problem. It is a growing pandemic with a heavy toll on morbidity and mortality. Dietary measures have proven to be ineffective […]

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Tikfu Gee, MBBS, MS, Kheng Wah Ong, MBBS, MS, Zubaidah Hanifa, MBBS, MS, Oo Myint Minn, MBBS, MS, Suriyana Ghani, MBBS, Shu Yu Lim, MD

Universiti Putra Malaysia

Morbid obesity is a serious health problem. It is a growing pandemic with a heavy toll on morbidity and mortality. Dietary measures have proven to be ineffective for the majority of morbidly obese patients. Currently only bariatric surgery can offer a reasonably good solution in weight loss management for these patients. However bariatric surgery itself is associated with both morbidity and mortality, especially with procedures requiring resection and anastomosis. Newer and less invasive techniques are being investigated and trials anticipated. This study compares early results of gastric plication surgery (GPS), banded gastric plication surgery (banded GPS), adjustable gastric band (AGB) alone and sleeve gastrectomy (SG). Methods: All patients fulfill the criteria of being morbidly obese and have failed an initial minimal 6 months of dietary management. The cases are non randomized as the patient decides upon the type of surgery after a detailed explanation of all the 4 procedures. The study period was from June 2011 to May 2012. All the procedures are performed laparoscopically and weight loss results compared upto the first 6 months after surgery. The technique of gastric plication involves intra-corporeal in-folding of the greater curvature of the stomach using non-absorbable braided sutures. Banded GPS have a band applied to the stomach after the plication. Good results were seen with both the banded GPS as well as the GPS alone and are comparable to AGB and SG. None of the cases were associated with post-operative morbidity and mortality.

In conclusion gastric plication surgery (GPS) and the banded GPS are both feasible techniques and results in good early weight loss. In addition these procedures are completely reversible without the risk of anastomotic leaks. Larger trials and long term results are anticipated.


Session: Poster Presentation

Program Number: ETP076

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Single Site Endoscopic Breast Lumpectomy: a case serieshttp://www.sages.org/meetings/annual-meeting/abstracts-archive/single-site-endoscopic-breast-lumpectomy-a-case-series/?utm_source=rss&utm_medium=rss&utm_campaign=single-site-endoscopic-breast-lumpectomy-a-case-series http://www.sages.org/meetings/annual-meeting/abstracts-archive/single-site-endoscopic-breast-lumpectomy-a-case-series/#respond Mon, 01 Jul 2013 17:59:57 +0000 http://www.sages.org/meetings/annual-meeting/abstracts-archive/single-site-endoscopic-breast-lumpectomy-a-case-series/ Suriyana Ghani, MBBS, Tikfu Gee, MBBS, MS, Shu Yu Lim, MD Universiti Putra Malaysia Breast lumpectomy is a common surgical procedure for benign breast lumps. Incisions made for lumpectomies vary and depend on the location of the breast lump. Circumareolar incisions are made whenever possible because of their aesthetic value. However some lumps are either […]

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Suriyana Ghani, MBBS, Tikfu Gee, MBBS, MS, Shu Yu Lim, MD

Universiti Putra Malaysia

Breast lumpectomy is a common surgical procedure for benign breast lumps. Incisions made for lumpectomies vary and depend on the location of the breast lump. Circumareolar incisions are made whenever possible because of their aesthetic value. However some lumps are either too large or are away from the areola resulting in an incision over the lump. These incisions are sometimes unacceptable to the patient, especially if the scar becomes hypertrophic or keloidal. Endoscopic lumpectomy is an emerging technique which avoids a cut directly on the breast but rather approaches the lump from the axilla. The resulting scar is more aesthtically acceptable to the patient. We report a series of 6 cases of single site endoscopic lumpectomy (SSEL). The inclusion criteria comprise of histologically proven benign breast lumps which are at least 4 x 4cm in size and are away from the areola. Patients with breast lumps that are malignant or those which can be excised with a circumareolar incision are excluded. The technique employs 2 ports side by side in a single incision made over the axilla. One port is for the camera and the other is for the use of an ultrasonic dissector (Harmonics scalpel). The procedure is performed under GA. A mean operating time of 55 minutes was recorded, with minimal blood loss. Drains are not used. Pain score recorded is low and the patients are followed up in the clinic for 6 months. One patient developed track hematomall the patients expressed satisfaction with the surgery and none developed keloids. The setbacks include a relatively longer operating time compared to open lumpectomy and the procedure has a steeper learning curve due to the absence of a potential space and the tracks need to be created. However with more awareness and demand, SSEL may be the emerging choice procedure for benign breast lumps.


Session: Poster Presentation

Program Number: ETP075

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Totally stapled gastrojejunal anastomosis using hybrid NOTES ? single 12 mm trocar approachhttp://www.sages.org/meetings/annual-meeting/abstracts-archive/totally-stapled-gastrojejunal-anastomosis-using-hybrid-notes-single-12-mm-trocar-approach/?utm_source=rss&utm_medium=rss&utm_campaign=totally-stapled-gastrojejunal-anastomosis-using-hybrid-notes-single-12-mm-trocar-approach http://www.sages.org/meetings/annual-meeting/abstracts-archive/totally-stapled-gastrojejunal-anastomosis-using-hybrid-notes-single-12-mm-trocar-approach/#respond Mon, 01 Jul 2013 17:59:57 +0000 http://www.sages.org/meetings/annual-meeting/abstracts-archive/totally-stapled-gastrojejunal-anastomosis-using-hybrid-notes-single-12-mm-trocar-approach/ Lino Polese, MD, PhD, Stefano Merigliano, MD, Gianfranco Da Dalt, MD, Roberto Luisetto, BD, Lorenzo Norberto, MD Department of Surgery, Oncology and Gastroenterology, Padova University, Italy Objective of the technology or deviceTo perform a totally stapled gastrojejunal anastomosis using hybrid NOTES –single 12-mm trans-abdominal trocar approach. Description of the technology and method of its use […]

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Lino Polese, MD, PhD, Stefano Merigliano, MD, Gianfranco Da Dalt, MD, Roberto Luisetto, BD, Lorenzo Norberto, MD

Department of Surgery, Oncology and Gastroenterology, Padova University, Italy

Objective of the technology or device
To perform a totally stapled gastrojejunal anastomosis using hybrid NOTES –single 12-mm trans-abdominal trocar approach.

Description of the technology and method of its use or application
A 12 mm Hasson trocar is positioned in the left hypocondrium and a gastroscope is introduced for the following maneuvers. By puncturing under vision the stomach from outside in two different places, two wires are passed through the anterior and posterior gastric wall, pulled and tied out of the mouth. After a jejunal loop is chosen, pulled out (after enlarging the trocar abdominal incision) and a 21 mm stapler anvil is introduced in it and closed with purse string on the loop antimesenteric site, the external part of the anvil is connected with a “cutting system” and then to the wire coming from the posterior gastric wall. By pulling the other wire from the outside, the cutting system reaches and passes through the posterior gastric wall, dragging the external part of the anvil into the stomach, while the internal part and the jejunal loop remain close to the posterior gastric wall. After removal of the cutting system through a small gastrotomy, a stapler is introduced, connected to the anvil and fired performing a circular stapled latero-lateral anastomosis between the posterior gastric wall and the jejunal loop. The gastrotomy is closed with a linear stapler.

Preliminary results if available
The procedure was carried out on 8 domestic pigs of 45 kg using a NOTES hybrid technique with a gastroscope and a 12-mm Hasson trocar, positioned in the left hypocondrium. In all cases the procedure was completed through a single 3 cm abdominal incision, without intraoperative complications. The mean operation time was 2 hours, and endoscopic investigation showed that the anastomoses were intact, patent and airtight. In survival models no complications were found during follow-up and anastomoses were regular and well-functioning at control.

Conclusions/Future directions Totally stapled gastrojejunal anastomosis using a hybrid NOTES –single 12 mm trocar approach is a simple and safe procedure in the porcine model. Further studies are warranted to evaluate the functional and metabolic results of this procedure. The cutting system connected with the anvil was required to perform the procedure.


Session: Poster Presentation

Program Number: ETP045

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Hydrodissector hook (A new device for safe dissection)http://www.sages.org/meetings/annual-meeting/abstracts-archive/hydrodissector-hook-a-new-device-for-safe-dissection/?utm_source=rss&utm_medium=rss&utm_campaign=hydrodissector-hook-a-new-device-for-safe-dissection http://www.sages.org/meetings/annual-meeting/abstracts-archive/hydrodissector-hook-a-new-device-for-safe-dissection/#respond Mon, 01 Jul 2013 17:59:57 +0000 http://www.sages.org/meetings/annual-meeting/abstracts-archive/hydrodissector-hook-a-new-device-for-safe-dissection/ Sait Bakir, MD This device (Hydrodissector hook) (Sait’s Hook) designed for dissect and cut tissue safely without damaging underlying tissues. This hook have a canal inside (like injection needles) so we can inject water from the tip hole of the hook. Before cutting or cautering surgeon inject water so it creates a safe working space.This […]

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Sait Bakir, MD

This device (Hydrodissector hook) (Sait’s Hook) designed for dissect and cut tissue safely without damaging underlying tissues. This hook have a canal inside (like injection needles) so we can inject water from the tip hole of the hook. Before cutting or cautering surgeon inject water so it creates a safe working space.This prevents us from unwanted thermal injury. Hydrodissection helps create safe dissection plane. Also it can be use for irrigation for small areas by using the hook.

1. body

2. handle

3. control button

5. cauter cable

6. water pipe

7. water

8. cauter generator

10. cauter control pedal

11. body cross-section

12. tip cross-section

1


Session: Poster Presentation

Program Number: ETP044

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Validation of a 3-D Surgical Navigation System for Laparoscopic Liver Ablation Procedures using a Human Cadaver Modelhttp://www.sages.org/meetings/annual-meeting/abstracts-archive/validation-of-a-3-d-surgical-navigation-system-for-laparoscopic-liver-ablation-procedures-using-a-human-cadaver-model/?utm_source=rss&utm_medium=rss&utm_campaign=validation-of-a-3-d-surgical-navigation-system-for-laparoscopic-liver-ablation-procedures-using-a-human-cadaver-model http://www.sages.org/meetings/annual-meeting/abstracts-archive/validation-of-a-3-d-surgical-navigation-system-for-laparoscopic-liver-ablation-procedures-using-a-human-cadaver-model/#respond Mon, 01 Jul 2013 17:59:57 +0000 http://www.sages.org/meetings/annual-meeting/abstracts-archive/validation-of-a-3-d-surgical-navigation-system-for-laparoscopic-liver-ablation-procedures-using-a-human-cadaver-model/ Chet W Hammill, MD, Maria A Cassera, Logan W Clements, PhD, Prashanth Dumpuri, PhD, James D Stefansic, PhD Liver and Pancreas Surgery Program, Providence Medical Center, Portland, OR and Pathfinder Technologies, Inc., Nashville, TN Objective The Explorer™ Minimally Invasive Liver (MIL) device is a 3-D image guidance system that is intended to be used as […]

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Chet W Hammill, MD, Maria A Cassera, Logan W Clements, PhD, Prashanth Dumpuri, PhD, James D Stefansic, PhD

Liver and Pancreas Surgery Program, Providence Medical Center, Portland, OR and Pathfinder Technologies, Inc., Nashville, TN

Objective

The Explorer™ Minimally Invasive Liver (MIL) device is a 3-D image guidance system that is intended to be used as a navigation aid during laparoscopic liver ablation procedures and to be used in conjunction with other standard of care intraoperative imaging modalities.

Description

Laparoscopic hepatic ablation procedures are currently performed under the guidance of intraoperative ultrasound, which is 2-D and requires considerable expertise. The Explorer™ MIL device is an experimental 3-D image-guidance system intended to be used in conjunction with ultrasound during laparoscopic liver ablation procedures. The Explorer™ MIL device allows for intraoperative surgical instrument tracking and the display of the location of tracked instrumentation on preoperative tomographic imaging and 3-D models of anatomical structures of interest. Additionally, the Explorer™ MIL device has the ability to track rigid laparoscopic ultrasound transducers and integrate the images into the 3-D model.

Preliminary Results

Determining the accuracy of tumor targeting using an ablation device during clinical procedures is a difficult problem. To overcome this problem, a human cadaver model re-perfused with a contrast agent solution was utilized. Seven to eight biopsy clips (UltraClip® Dual Trigger Breast Tissue Marker, Bard Biopsy Systems, Tempe, AZ) visible on both ultrasound and CT were distributed throughout the liver in five cadavers. After the biopsy clips were placed, a “preoperative” CT was acquired of the cadaveric specimen for use in the Explorer™ MIL device. After randomization the clips were targeted using either laparoscopic ultrasound alone or laparoscopic ultrasound in conjunction with the Explorer™ MIL device. Two different percutaneous ablation instruments, the Covidien Evident™ MWA antenna or the Angiodynamics StarBurst® Xli-enhanced RFA probe, were used for targeting. Once the tip of the probe was placed as close as possible to the specified target it was fixed in place and a “postoperative” CT was acquired. Over all of the ablation probe placements (N = 37), the mean distance between instrument tip and target marker was found to be 8.7±7.5mm for probe placements performed with laparoscopic ultrasound guidance and 6.8±3.8mm for probe placements using the Explorer™ MIL device in concert with laparoscopic ultrasound.

Conclusions & Future Directions

The results from the human cadaver evaluation of the Explorer™ MIL device indicate that there is a potential for the 3-D navigation system to provide some incremental benefit in laparoscopic ablation procedures. Future directions of the Explorer™ MIL device include more extensive evaluation of the benefit provided by tracked laparoscopic ultrasound and the interactive 3-D display of the ultrasound information. Additionally, ongoing research and development efforts are being made to transition to a electromagnetic tracking system which will allow for more accurate tracking of non-rigid surgical instrumentation.


Session: Podium Presentation

Program Number: ET007

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Endoscope Handle Manipulatorhttp://www.sages.org/meetings/annual-meeting/abstracts-archive/endoscope-handle-manipulator/?utm_source=rss&utm_medium=rss&utm_campaign=endoscope-handle-manipulator http://www.sages.org/meetings/annual-meeting/abstracts-archive/endoscope-handle-manipulator/#respond Mon, 01 Jul 2013 17:59:57 +0000 http://www.sages.org/meetings/annual-meeting/abstracts-archive/endoscope-handle-manipulator/ Luca Milone, MD, Ian Dardani, BS, Mallory Hennemuth, BS, David Straple, BS, Maria Torres, BS, Andrew Gumbs, MD Villanova Endoluminal surgery has developed tremendously over the past few years, and the addition of robotic instruments could be very helpful in continuing the development of this field. The Endoscope Handle Manipulator is designed to robotically control […]

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Luca Milone, MD, Ian Dardani, BS, Mallory Hennemuth, BS, David Straple, BS, Maria Torres, BS, Andrew Gumbs, MD

Villanova

Endoluminal surgery has developed tremendously over the past few years, and the addition of robotic instruments could be very helpful in continuing the development of this field. The Endoscope Handle Manipulator is designed to robotically control standard endoscopes. It will create a stable platform and reduce the number of physicians and technicians required for procedures. The Endoscope Handle Manipulator has a U.S. patent application (SN 61/026,819) and an International Application (No. WO/2009/099633).

The device places the basic control interface of the endoscope into a pad which is controlled by the foot. It contains three main subsystems: a control pad, a manipulator, and insertion rollers. The control pad contains a circular bevel foot pedal with directional controls. The physician controls the movement of the distal end by stepping on the control pad. The control pad also contains a foot pedal that controls the insertion and retraction of the endoscope. The handle manipulator snaps onto the endoscope handle and is held in place by a pole stand for hands-free use. The manipulator contains motors which engage the endoscope knobs and buttons according to inputs from the control pad. The insertion rollers feed the distal end in and out of the patient and will connect to the bed for stability. The insertion rollers allow the tube to be engaged or disengaged mid-procedure. The prototype being developed is designed specifically for the Fujifilm G-5 series.

The Endoscope Handle Manipulator will simplify the performance of procedures such as: POEM, ERCP, NOTES, any endoluminal procedure for GERD and revisional bariatric surgery such as stoma and pouch reduction after gastric bypass.The Endoscope Handle Manipulator is expected to be readily adopted by endoscopists and surgeons within the next decade due to its added functionality and compatibility with existing commercial endoscopes.


Session: Poster Presentation

Program Number: ETP043

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First Clinical Experience with the TransPyloric Shuttle (TPS(r)) Device, a Non-Surgical Endoscopic Treatment for Obesity: Results from a 3-Month and 6-Month Studyhttp://www.sages.org/meetings/annual-meeting/abstracts-archive/first-clinical-experience-with-the-transpyloric-shuttle-tpsr-device-a-non-surgical-endoscopic-treatment-for-obesity-results-from-a-3-month-and-6-month-study/?utm_source=rss&utm_medium=rss&utm_campaign=first-clinical-experience-with-the-transpyloric-shuttle-tpsr-device-a-non-surgical-endoscopic-treatment-for-obesity-results-from-a-3-month-and-6-month-study http://www.sages.org/meetings/annual-meeting/abstracts-archive/first-clinical-experience-with-the-transpyloric-shuttle-tpsr-device-a-non-surgical-endoscopic-treatment-for-obesity-results-from-a-3-month-and-6-month-study/#respond Mon, 01 Jul 2013 17:59:57 +0000 http://www.sages.org/meetings/annual-meeting/abstracts-archive/first-clinical-experience-with-the-transpyloric-shuttle-tpsr-device-a-non-surgical-endoscopic-treatment-for-obesity-results-from-a-3-month-and-6-month-study/ George Marinos, MBBS, FRACP, MD, Chris Eliades, MBBS, V. Raman Muthusamy, MD, Kobi Iki, MS, Cliff Kline, Hugh L Narciso, MSc, Daniel Burnett, MD Prince of Wales Private Hospital (Sydney, NSW, AUS); BAROnova, Inc. (Goleta, CA, USA) Objective: The TransPyloric Shuttle® (TPS®) is a non-surgical device that is delivered endoscopically to the stomach and is […]

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George Marinos, MBBS, FRACP, MD, Chris Eliades, MBBS, V. Raman Muthusamy, MD, Kobi Iki, MS, Cliff Kline, Hugh L Narciso, MSc, Daniel Burnett, MD

Prince of Wales Private Hospital (Sydney, NSW, AUS); BAROnova, Inc. (Goleta, CA, USA)

Objective: The TransPyloric Shuttle® (TPS®) is a non-surgical device that is delivered endoscopically to the stomach and is intended to enable significant weight loss for obese patients.

Description: The TransPyloric Shuttle has a functional shape consisting of a large spherical bulb connected to a smaller cylindrical bulb by a flexible tether and is composed primarily of medical grade silicone. In its functional, constructed state, the larger bulb assumes a shape of sufficient diameter to prevent migration from the stomach. The smaller bulb passes freely into the duodenum during normal peristalsis, allowing the device to self-orient and assume transpyloric positioning. Once transpyloric, the compliant base of the larger bulb engages the pylorus directly to create an intermittent seal intended to reduce the rate of gastric outflow, enabling an overall reduction in caloric intake and weight loss.

Method: TPS delivery and removal procedures are performed in outpatient endoscopic settings using a standard gastric overtube for access and esophageal protection. The device is preloaded in a delivery catheter as a low-profile, single-helical coil elongated to 65 cm for transoral delivery. During deployment, the delivery catheter is inserted through a pre-placed overtube, and the helical coil is dispensed into the stomach where the coil assumes its functional shape. Delivery is complete when the delivery system locks and releases the formed TPS. The device then resides in the stomach for the desired treatment period. During removal, an endoscope is inserted into the stomach through an overtube and standard endoscopic instruments are used to unlock, capture and remove the deconstructed TPS through the overtube.

A prospective, open-label, non-randomized, single-center study was approved and conducted to evaluate the safety and efficacy of the procedure and device. Twenty subjects with a mean body mass index (BMI) of 36.0 kg/m2 ± 5.4 kg/m2 were enrolled. Subjects were serially assigned to three-month and six-month treatment cohorts. Throughout the study, surveillance endoscopies were performed to evaluate the device and gastric tissues. Primary outcomes measured included percentage of excess weight loss (EWL) using the BMI method, total weight loss (WL), and adverse events.

Results: All devices were deployed and retrieved in 20 patients without complication. Mean procedure times for delivery and retrieval were 10.3 minutes ± 3.9 minutes and 12.9 minutes ± 6.4 minutes, respectively. Patients demonstrated minimal transient intolerance to the TPS and were able to quickly return to normal daily activity. Three-month patients demonstrated a mean EWL of 31.3% ± 15.7% and a mean WL of 8.9 kg ± 5.2 kg. Six-month patients achieved a mean EWL of 50.0% ± 26.4% and a mean WL of 14.6 kg ± 5.7 kg. Observations of persistent gastric ulceration in two patients resulted in the decision to remove both devices approximately one to two weeks prior to their scheduled removal dates. Both patients recovered fully with no residual adverse effects.

Conclusions: The TPS provides a safe and reliable non-surgical method for weight loss with exceptional patient tolerance compared to surgical weight loss interventions.


Session: Podium Presentation

Program Number: ET013

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Glove Technique in Single-Port Access Laparoscopic Cholecystecyomy: Results Base on the Learning Curve Analysis.http://www.sages.org/meetings/annual-meeting/abstracts-archive/glove-technique-in-single-port-access-laparoscopic-cholecystecyomy-results-base-on-the-learning-curve-analysis/?utm_source=rss&utm_medium=rss&utm_campaign=glove-technique-in-single-port-access-laparoscopic-cholecystecyomy-results-base-on-the-learning-curve-analysis http://www.sages.org/meetings/annual-meeting/abstracts-archive/glove-technique-in-single-port-access-laparoscopic-cholecystecyomy-results-base-on-the-learning-curve-analysis/#respond Mon, 01 Jul 2013 17:59:57 +0000 http://www.sages.org/meetings/annual-meeting/abstracts-archive/glove-technique-in-single-port-access-laparoscopic-cholecystecyomy-results-base-on-the-learning-curve-analysis/ Hon Phin Wong, MD, Hurng-Sheng Wu, MD, Dev-Aur Chou, MD, Shih-Wei Huang, MD Show Chwan Memorial Hospital OBJECTIVE: Cholecystectomy lends itself well to a single-incision laparoscopic surgery (SILS) approach. SILS is a virtually “scarless” technique; the single port is hidden in the umbilicus. As these procedures have become more widely adapted, it is important to […]

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Hon Phin Wong, MD, Hurng-Sheng Wu, MD, Dev-Aur Chou, MD, Shih-Wei Huang, MD

Show Chwan Memorial Hospital

OBJECTIVE: Cholecystectomy lends itself well to a single-incision laparoscopic surgery (SILS) approach. SILS is a virtually “scarless” technique; the single port is hidden in the umbilicus. As these procedures have become more widely adapted, it is important to determine the approximate learning curve to decrease two surgical endpoints: time to completion of the procedure; and, decreased incidence of conversion.

METHODS: We retropectively reviewed our series of 136 cholecystectomies using the SILS approach between Feb 2009 to Nov 2012. The access was made by a standard wound protector and a size 7 glove through the unbilicus. A series of little accesses were then made on the tips of the glove-fingers and the trocars were fitted into it and fixed by surgical knotting. We usually use two 5mm and a 10mm ports: 5mm ports for hand instruments and 10mm ports for the laparoscope, while clip applicator was introduced via the 4th finger access without trocar. Pneumoperitoneum was induces through the 10mm port during the operation

RESULTS: Of the 119 patients, average length of time for cases was 1 hour 28 minutes with a range between 35 minutes and 215 minutes. The average length of time for the first 25 cases was 99 minutes. When compared with cases in the 2nd, 3rd and 4th quintiles, the average length of time were 101 minutes, 87 minutes and 77 minutes; while the percentage of operation that can be completed within 90 minutes were 40%, 64% and 80%, respectively. Conversion was accomplished through the addition of a 5-mm port elsewhere on the abdominal cavity, with the rate of 9.2%. The postoperative course was uneventful in all patients.

CONCLUSIONS: The learning curve for successful consistent completion of SILS cholecystectomy cases appears to be after 50 cases. Conversion can be done by advancing an additional port on the abdomen without open surgery.


Session: Poster Presentation

Program Number: ETP042

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Development of Multi-Channel Shape-Locking Overtube Consisting of Vacuum Packed Particles for Colonosocpehttp://www.sages.org/meetings/annual-meeting/abstracts-archive/development-of-multi-channel-shape-locking-overtube-consisting-of-vacuum-packed-particles-for-colonosocpe/?utm_source=rss&utm_medium=rss&utm_campaign=development-of-multi-channel-shape-locking-overtube-consisting-of-vacuum-packed-particles-for-colonosocpe http://www.sages.org/meetings/annual-meeting/abstracts-archive/development-of-multi-channel-shape-locking-overtube-consisting-of-vacuum-packed-particles-for-colonosocpe/#respond Mon, 01 Jul 2013 17:59:56 +0000 http://www.sages.org/meetings/annual-meeting/abstracts-archive/development-of-multi-channel-shape-locking-overtube-consisting-of-vacuum-packed-particles-for-colonosocpe/ Rodiyan Gibran Sentanu, BEng, Masayuki Teranuma, BEng, Takuro Ishii, MEng, Kazuya Kawamura, PhD, Tatsuo Igarashi, MD, PhD Department of Medical System Engineering, Division of Artificial Systems Science, Graduate School of Engineering, Chiba University, Chiba, Japan Objective of the device One of the impediments of modern endoscopy, especially in the colonoscopy, is the formation of undesired […]

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Rodiyan Gibran Sentanu, BEng, Masayuki Teranuma, BEng, Takuro Ishii, MEng, Kazuya Kawamura, PhD, Tatsuo Igarashi, MD, PhD

Department of Medical System Engineering, Division of Artificial Systems Science, Graduate School of Engineering, Chiba University, Chiba, Japan

Objective of the device

One of the impediments of modern endoscopy, especially in the colonoscopy, is the formation of undesired loops in the shaft of a flexible endoscope. Loop formation may prohibit expeditious and safe passage of the scope from the rectum to the cecum by dispersing the force of pushing the scope forward by converting it into pushing the wall of the colon or mesentery. Common adjunct maneuvers used to avoid loop formation are the handling of external abdominal pressure or alteration of patient’s positioning. Although oftentimes successful, these maneuvers are labor intensive and may hinder the efficiency of the endoscopy unit. We developed a multi-channel shape-locking overtube device that has controllable rigidity to lock the route of inserting the endoscope advancing and withdrawing inside the digestive tract.

Description of the technology and method of its use or application

The device consists of a multi-channel overtube as shape-locking device and a semirigid overtube as insertion tools. The multi-channel overtube was consisting of foil tube which separated into several segment. Each segment, 10 cm in length, was filled with particles and connected with vacuum device via small plastic tube. The particles will rigidify by creating a vacuum in each tube segment. Before insertion, the multi-channel overtube was set inside semirigid overtube in flip condition. Overtube are inserted by pushing the semirigid overtube following the endoscope. Each segment are then rigidify after it was deploy on each position. After the endoscope reach the target, multi-channel overtube will completely turn into rigid body and semirigid overtube should be removed in order to gain more space inside the multi-channel overtube. The overtube system was verified to function as an effective method to prevent the formation of undesired loop. This system also provide stable and fix route from rectum into desired target that also enables exchange of multiple devices without any risks for hurting the colon wall which caused by friction with devices. Thus, it will enable surgeon to perform more complicated surgery by providing many kind of surgery devices.

Fig.1 Outline of multi-channel shape-locking overtube system inside colon

Preliminary results

Using the prototype model, the multi-channel shape-locking overtube system worked in extending and rigidifying action, It was clarified that balance between required diameter and rigidity of the overtube are important because the rigidity of the system depends on its thickness.

Conclusions/Future directions

The multi-channel shape-locking overtube system was able to prevent undesired loop and also might increase the possibility of performing other kind of surgery which cannot be done under conventional endoscope. More study is mandatory in order to make the system one of clinical tools in the future through determining the adequate materials that will fulfill thinness and rigidity.


Session: Poster Presentation

Program Number: ETP041

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