A New Device Facilitating Intracorporeal Purse-string Suture during Endoscopic Surgery

K. Kijima, J. Tanaka, Shiori Shibata, Hideyuki Oyama, Toshimitsu Shiozawa, Yuki Takahashi, Tetsuji Wakabayashi, Ryuichi Sekine, Y. Harada, T. Uchida, T. Umemoto, G. Kigawa, K. Matsuo, Kuniya Tanaka
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Abstract

: Standard laparoscopic colorectal surgery requires additional incision or enlargement of the trocar incision for the retrieval of the surgical specimen. A natural orifice specimen extraction ( NOSE ) procedure, in which the specimen is retrieved through the anus or vagina without any additional skin incision, requires purse-string suture ( PSS ) of the rostral intestinal segment in order to fix the anvil head of the stapler and perform extracorporeal mechanical anastomosis. Colorectal surgery has a limited NOSE in cases where the end of the rostral segment could be pulled through the anus. Broader application of NOSE depends on intracorporeal PSS. We developed a new forceps for intracorporeal PSS during NOSE and evaluated its efficacy. The PSS instrument was refined to pass through a 12-mm trocar in an intracorporeal PSS and achieve anastomosis using double stapling. In trials utilizing an endoscopic practice box, regular spacing of stitches during PSS were consistent ( n = 10 ) , and tight intracorporeal anastomosis of the porcine colon was successfully performed ( n = 2 ) . We then confirmed efficacy through an operation on a pig. Our novel PSS device will help us perform NOSE not only in laparoscopic colorectal surgery but also in any operation requiring intracorporeal PSS, which should contribute to further advances in endoscopic digestive
一种用于内镜手术中囊内缝合的新型装置
标准的腹腔镜结直肠手术需要额外的切口或扩大套管针切口,以便取出手术标本。自然口标本提取(NOSE)手术,标本通过肛门或阴道取出,无需任何额外的皮肤切口,需要鼻侧肠段的钱包线缝合(PSS),以固定吻合器的砧头并进行体外机械吻合。结直肠手术有一个有限的鼻子,在情况下,吻端段的末端可以通过肛门拉。鼻鼻的广泛应用有赖于体内PSS。我们研制了一种用于鼻鼻术中体内PSS的新型钳,并对其疗效进行了评价。PSS器械经过改进,通过一个12mm套管针在体内PSS,并实现双吻合器吻合。在使用内窥镜练习箱的试验中,PSS期间的缝合间距是一致的(n = 10),并且成功地进行了猪结肠的紧密体内吻合(n = 2)。然后我们通过对猪的手术证实了疗效。我们的新型PSS装置不仅可以帮助我们在腹腔镜结肠手术中进行鼻手术,还可以在任何需要体内PSS的手术中进行鼻手术,这将有助于内窥镜消化的进一步发展
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