Duodenal Balloon Occlusion System for Hybrid-notes

(Objective of the device) Recently we introduced Hybrid-NOTES procedure for gastric GIST, which was combined procedure with laparoscopic surgery and flexible endoscope by surgeon and endscopists. During this procedure, we apply endoscope by CO2 gas insufflation but we encountered one problem, which is that CO2 gas flew into small intestine. It made worse laparoscopic view during operation and it made more operation time. To avoid this problem, We invented duodenal balloon occlusion system and this problem has resolved.

(Discription of the device) Our occlusion system was made from a balloon for esophageal variceal sclerotherapy. We put a loop of nylon suture at the tip of this balloon to grasp by endoscopic wire forceps. At the beginning of the procedure, we put this balloon at the bulbs of duodenum. With the nylon suture loop held by wire forceps, the balloon was first inserted down to the descending part of the duodenum then pulled up to the bulbus without injecting air and placed in the bulbus duodeni. Then balloon was inflated by injecting 60-70 ml of air to fix in this place. During procedure, no gas was advanced to the small intestine. After procedure, balloon air was deflated and pulled out easily from the mouth.

(Preliminary results) We used this system for 6 cases of Hybrid-NOTES procedure. We had enough expansion of stomach for endoscopic resection but no gas advanced to small intestine. Then laparoscopic closure of gastric wall could be done without unexpected small intestinal expansion. Complication was not seen in these 6 cases. This device was more economical and easier to use than laparoscopic intestinal clamp forceps.

(Conclusion) This duodenal occlusion balloon system is very useful for gastric laparoscopic surgery and Hybrid-NOTES, which is conducted with endoscopy.

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