Kazuhiro Kijima, MD, Jun-ichi Tanaka, PhD, MD, FACS, Takashi Kato, PhD, MD, Takahiro Umemoto, PhD, MD, Sumito Sato, PhD, MD, Kazuaki Yokomizo, PhD, MD, Kazuki Shinmura, MD, Yoshikuni Harada, MD, Ryu-ichi Sekine, MD, Hideyuki Oyama, MD. Showa University Fujigaoka Hospital
Background: Laparoscopic colorectal resection is now commonly performed worldwide, and outcomes are comparable to those of open surgery. Invariably, however, standard laparoscopic colorectal resection requires enlargement of one of the trocar incisions for extraction of the surgical specimen from the abdominal cavity. Enlarging the incision increases the risk of wound complications, such as persistent wound pain and abdominal incisional hernia. Natural orifice transluminal endoscopic surgery (NOTES), which is an ideal surgery in terms of avoiding these and other issues, has not gained popularity, mainly because of the difficulty of the technique and the fact that it and the devices are still under development. There is a specimen extraction method that is applicable to conventional laparoscopic surgery and does not require widening the incision. By this method, known as the natural orifice specimen extraction (NOSE) procedure, the surgical specimen is retrieved via the anus or vagina. The NOSE procedure is advantageous because it avoids undue surgical stress. To date, however, application of the NOSE procedure to colectomy has been restricted to cases in which both the resection and anastomosis can be performed extracorporeally.
Purpose: To facilitate adaptation of the NOSE procedure to all cases of laparoscopic colectomy, not only those in which colon is exteriorized, we invented a device by which purse-string suturing can be performed intracorporeally.
Method: We worked with a company to develop the new PSI device, which is a forceps-like device that is designed to ensure suturing as reliable and safe as that is achieved extracorporeally. The PSI, which is 6 cm long and hinged, can be passed in and out the body cavity through the 12-mm trocar. It is used to grasp and hold the colon across its open end, and the suture needle and thread are passed through a channel in the device and thus through the tissue in a smooth movement.
Conclusion: Our newly developed device provides for intracorporeal purse-string suturing during endoscopic surgery and thus allows unrestricted application of the NOSE procedure to laparoscopic colorectal resection. We believe the device will be useful not only for colectomy but also for surgeries such as esophagectomy and total gastrectomy that require purse-string suturing. We expect use of the device to contribute to the progression of endoscopic surgery.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 84279
Program Number: ETP741
Presentation Session: Emerging Technology Poster
Presentation Type: Poster