Sam Sharma, Kota Momose, Jeffrey Milsom. Weill Cornell Medical College
Objective of the technology or device: Historically, performing mucosally orientated intestinal advanced surgical procedures, known as endolumenal surgery, has been limited to commercially available endoscopes (CAE) using electrosurgical tools. Although this technology hasn’t evolved considerably in almost half a century, procedures such as EMR and ESD, permitting complex polypectomy and recently full-thickness resection have been enabled. Recently, the addition of procedures such as rectal ESD and TAMIS have fuelled the need for more therapeutically focussed technology to facilitate such procedures. Such need has led to the recent release of endoscopic mechanically actuated ‘robot’ technology able to perform intricate intestinal procedures. Such technology, although with clear advantages may be prohibitively expensive particularly in the current cost conscious healthcare climate with such technologies utlilty in conventional surgery still questionable. A clear need exists for a cost-effective solution to endolumenal surgical technology that can be adapted to existing CAE equipment in use globally. Here we report the initial description and characteristics of a unique prototype add-on platform for CAE, designed and developed in collaboration with Minimally Invasive Technology Program of Cornell University and Lumendi LLC (CT, USA).
Description of the technology and method of its use or application: The platform consists of a double balloon oversheath that can be added to varying diameter CAE. The double balloon system provides stability and retraction capabilities. Within the sheath two 5mm channels exit into an area in-front of the endoscope tip. We also designed and developed a grasper and electrocautery enabled scissor. Both instruments were flexible as to permit passage alongside the endoscope in complex intestinal geometry. The tip of both instruments are articulating and can be controlled by the operator i.e the section of the instrument in front of the endoscope tip can be positioned independently through instrument handle thumb joysticks. We tested the prototypes to perform a complex polypectomy, stapleing use as well as suturing.
Preliminary results if available: The endolumenal surgical platform enabled complex polyp tumour dissection using the articulating grasper and electrosurgical scissors. The scissors enabled, cold cutting, hot cutting and knife use when the blades were closed. Upon appropriate dissection, the oversheath enabled passage of a linear stapler to facilitate rapid tumour removal. After tumour removal, successful defect closure was enabled through the endolumenal suturing of a 2.0 v-lock suture using 2 graspers.
Conclusions / future directions: This study presents the first ever description of these prototypes and a method that provides full endolumenal surgical capabilities using simple add-on disposable technology to commercially available endoscopes. The double balloon system provided stability and improved visualisation. When the flexible instruments were added, full tumour removal was possible as well as additional procedures such as stapling and suturing. In future we will apply this technology and methods to a wide variety of gastrointestinal procedures. Such technology may obviate the use of expensive alternatives, potentially providing the same functionality as their more expensive and capital equipment necessitating counterparts.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 91131
Program Number: ETP859
Presentation Session: Emerging Technology iPoster Session (Non CME)
Presentation Type: Poster