Sanjiv P Haribhakti, MS, DNB, MCh. Kaizen Hospital, Institute of GE
Objective of the technology or device – Development of new Transoral rigid surgical platform for performing NOTES surgery of the UGI tract, notably transoral cardiomyotomy for achalasia cardia
Description of the technology and: Transoral endoscopic surgery (TOES) of the oesophagus, GE junction & stomach using a rigid operating platform has never been developed or performed to the best of our knowledge. This access route for performing various UGI surgeries is novel & is the central idea of the current innovation. Transoral port (TOP), a new innovative platform of 2cm diameter has been developed & tested in animal models & human cadaveric dissections. This platform is inserted under vision with a blunt introducer, in the centre of which is an opening to admit 5mm telescope ensuring under vision introduction. At the proximal end of the sheath is a screwing mechanism for attachment of diaphragm. The diaphragm has a silicon washer applied on it, on which multiple holes are created to pass multiple 3mm or 5mm laparoscopic instruments. One of diaphragm has 3 opening called 5,5,5 diaphragm, while another has two openings for 5mm & 10mm instrument called 10,5 diaphragm. These diaphragms are interchangeable with the same sheath.
Method of its use & applications: Transoral Endoscopic myotomy (TOEM) for Achalasia Cardia – A new approach for cardiomyotomy is innovated with the transoral platform to perform with rigid operating oesophagoscope. This procedure is being termed as transoral endoscopic myotomy (TOEM). This is a novel approach for doing myotomy. The advantages of TOEM over POEM are:
1. TOEM is performed with a rigid surgical platform which is more stable & controlled environment to perform surgical procedures performed by surgeons.
2. Suturing of the mucosal defect – Endoscopic suturing is only possible with a rigid platform. Currently with flexible endoscopy suturing is not possible as there is only one instrument. Thus POEM uses clips for mucosal closure.
3. Fundoplication – With cardiomyotomy, there is an increased risk of gastro-oesophageal reflux, thus partial fundoplication is added along with laparoscopic cardiomyotomy. However, with POEM, Fundoplication is not technically possible. With TOEM, fundoplication can be achieved with another long platform & suturing can be performed with hand suturing using a standard needle holder or with EndostitchTM.
Preliminary results: This technique has been tested in animals & human cadaveric dissection & has been found to be technically feasible. Main challenges relate to the small diameter of the port & a small working channel creating difficulties for instrumentation. However several limitations of current instrumentation have been overcome by development of new set of instruments.
Conclusions/Future directions: Transoral surgery of the Oesphagus, GE junction & Stomach is feasible with a development of transoral port which forms a stable surgical platform to perform transoral cardiomyotomy for achalsia cardia. Now, human trials are needed to test this operative platform to perform NOTES UGI Surgery. In the future, several NOTES procedures by this new technological platform can be perfomed such as Transoral Fundoplication(TOF) for hiatal hernia, transoral bariatric surgeries (TOBS) & NOTES oesophagectomy.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 84344
Program Number: ETP735
Presentation Session: Emerging Technology Poster
Presentation Type: Poster