Transgastric Cholecystectomy Using the Endosamurai – A Novel Endoscopic Operating Platform

One of the basic operating tenets in surgery is the principle of traction/countertraction. This ability is significantly hampered when performing NOTES procedures using standard flexible endoscopes with parallel instrument channels. New technologies must be developed to obtain the dexterity offered by laparoscopic surgery. We demonstrate a transgastric cholecystectomy in a porcine model using a prototype device designed to maximize degrees of freedom using novel articulating endoscopic “arms.”

The EndoSamurai (Olympus, Tokyo, Japan) is a newly developed endoscopic platform that utilizes three channels (two articulating, one non-articulating) with specialized instruments. It was deployed through a steerable endoscopic overtube into the stomach of a 50 kg pig. Needle cautery was used to create a gastrotomy. The endoscope was easily directed to the right upper quadrant. Endoscopic graspers, cautery and clips were used to dissect the gallbladder as demonstrated in the video. A standard 5 mm laparoscope was also used to observe the procedure.

Compared to existing endoscopic surgical platforms, the EndoSamurai represents an endoscope that provides the operator with the ability to provide traction/countertraction through a single endoscopic port. In addition, directable instrument arms allow 5 degrees of freedom for instruments resulting in significant benefits in manual dexterity and ergonomics. Furthermore, the EndoSamurai platform represents a significant step towards the achievement of several NOSCAR white paper initiatives, including the development of a stable working platform, image display and maintenance of spatial orientation, and tissue approximation methods.

Session: Video Channel

Program Number: V056

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