Establishment of Local Immunotherapy and Stem Cell Regeneration Therapy for Intra Abdominal Solid Tumor By Multi Piercing Surgery (Needlescopic Surgery with NOTES): Possibility of Ultra-Minimally Invasive Surgery By Needle-Type Robots

Takeshi Ohdaira, MD, Norifumi Tsutsumi, MD, Megumu Mori, MD, Kyo Jo, MD, Makoto Hashizume, MD. Department of Advanced Medicine and Innovative Technology, Kyushu University Hospital

Objectives: A number of minimally invasive therapeutic procedures by single port surgery (SPS) have been proposed. However, there exist the following issues: 1) the flaw that the triangular formation for the target site of treatment is impossible to establish; and 2) clashing among multiple SPS instruments in the single port. We established Multi Piercing Surgery (MPS), which is a Needlescopic Surgery (NS) assisted by NOTES. We used a 3-mm diameter needle-type robot that forms several piercings at the cutaneous insertion site on the abdominal wall that are impossible to detect macroscopically after removal. We thus successfully conducted a preclinical study on local immunotherapy and local regeneration therapy using adipose-derived stem cells for intra-abdominal tumor containing pancreas cancer. Description: The needle robot has one joint of 3 mm in diameter and possesses the following motion capabilities: 360-degree rotation and 90-degree flexion in the long axis direction at the joint; and 25-degree grasping function at the hand. Furthermore, the robot has a mono-polar electric power source at the hand tip as a handling function. The robot was used to perform the study in two pigs. At first we selected pancreatic cancer as the target tumor. The tip of the robot hand was used to slightly incise the retroperitoneum on the pancreatic surface by electrocoagulation, and the retroperitoneum was detached from the pancreatic parenchyma along about 5 mm. Subsequently, the robot hand was used to lead a catheter whose inner lumen surface was coated with anticoagulant ligand-that had originally been developed to administer therapeutic cells-into the detached pocket. The catheter was used to inject immune cells and adipose-derived stem cells while not applying a pressure load on the pancreas, and the treatment was completed. Results: In laparotomy via the ventral approach, two needle robots achieved complete triangular formation and allowed the conduct of surgery under a good visual field. The grasping and traction of the greater omentum, the upward mobilization of the stomach and the downward traction of the colon to expose the front part of the pancreas, and other actions were performed by the 90-degree flection of the 3-mm diameter robot hand. The dorsum of the 25-mm long robot hand was used to very smoothly perform the procedure without damaging the organ. Furthermore, the retroperitoneum could also be incised easily by electrocoagulation with the tip of the robot hand, which shortened time to reach the pancreas. Times required between the abdominal piercing with the two robots and the injection of the therapeutic cell solution, were 18 minutes and 23 minutes respectively. Furthermore, any complications such as bleeding and leakage of pancreatic juice did not occur during administration. Conclusions: MPS by the needle-type robots left no visible surgical scar in the abdominal wall and was successfully verified to allow the completion of safe and efficacious surgical procedures under a good field of vision by ensuring the triangular formation that is indispensable for endoscopic surgery.

Session: Emerging Technology Poster
Program Number: ETP009
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