U.S. National Library of Medicine
National Institutes of Health
Surg Innov. 2009 Jun;16(2):104-10. Epub 2009 May 1.
Development and validation of a new generation of flexible endoscope
Swanström L, Swain P, Denk P.
Division of Minimally Invasive Surgery, Legacy Health System, 1040 NW 22nd Avenue, Suite 560,
Portland, OR 97210, USA. firstname.lastname@example.org
BACKGROUND: The concept of intraperitoneal flexible endoscopy has created much interest and
investigation. Both gastroenterologists with a surgical leaning and surgeons with advanced endoscopy
interests are researching the feasibility of this new approach. Current flexible scopes and instruments are
extremely limited for use in natural orifice transluminal endoscopic surgery (NOTES). We describe the
development of an endoscopic system specifically designed for endoluminal and NOTES procedures and
demonstrates benefits and efficacy in benchtop and cadaver models. TECHNIQUE: In conjunction with
industry, an 18-mm 4-channel rigidizing access device was designed. Measurements of the strength
(torsional and lifting) of standard endoscopes and the new scope were made. The new device and
instruments are used in 8 cadavers to document its feasibility in a variety of specific tasks: endoluminal
plication, upper abdomen and lower abdomen visualization, bowel manipulation, solid organ retraction,
cholecystectomy, and enterotomy closure. RESULTS: Benchtop comparison between a standard scope
and the new scope showed equal maneuverability but the newer scope had greater force delivery at the tip
(0.042 vs 1.96 lb, P < .001) and greater instrument application force (0.09 vs 0.23 lb, P < .002).
Introduction of the scope was possible in all cadavers but difficult in cadavers <60 kg. Intragastric
manipulation was feasible and exiting the stomach was possible although it required a 2-cm gastrotomy.
The scope system was maneuverable in both lower quadrants without difficulty. The upper abdomen was
viewable, with variable success in steering the scope between left and right quadrants. The entire
gastrointestinal tract was able to be visualized in most cadavers. The scope generated sufficient force to
lift and manipulate intraabdominal structures. Cholecystectomy was successful in 5 of 5 attempts.
CONCLUSION: A new flexible access endoscope with 4 large access channels showed utility in a cadaver
model-satisfying some of the requirements for performance of NOTES procedures.
PMID: 19411279 [PubMed - indexed for MEDLINE]
Endoscopy, Digestive System*
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