Abstract
BackgroundA reliable and sterile access through the intestinal wall to ease flexible endoscopic transluminal interventions is still appealing but lacks a suitable port system.MethodsIn a granted industry cooperation, we developed the MIEO-Port, a flexible three components overtube system that provides a temporary hermetic sealing of the intestinal wall to allow endoscopic disinfection and manipulation to gain access to the abdominal cavity. The port features an innovative head part which allows for coupling the port to the intestinal wall by vacuum suction and for controlled jetting the isolated intestinal surface with a disinfectant. The device was tested in vivo in 6 pigs for acute and long-term usability. All animal tests were approved by the local ethics committee.ResultsIn the acute experiment, the port system supported sealed endoscopic mucosa resection and transluminal cholecystectomy. In the survival study on 5 animals, the MIEO-Port proved its reliability after transcolonic peritoneoscopy. In one animal, a port dislocation occurred after extensive retroperitoneal preparation, one animal revealed bacterial contamination at necropsy; however, all animals showed a favourable course over ten days and offered no signs of peritonitis or abscedation during post-mortem examination.DiscussionTo the best of our knowledge, the MIEO-Port system is the first device to provide a reliable and sterile flexible access to the peritoneal cavity that can be used throughout the entire gastrointestinal tract regardless of the access route and which combines hermetic sealing with local sterilization. Further studies are warranted.
Highlights
A reliable and sterile access through the intestinal wall to ease flexible endoscopic transluminal interventions is still appealing but lacks a suitable port system
Linke et al in 2013 proposed a balloon occluder to be placed cephalad to the penetration site [3, 4] and which was tested against conventional laparoscopic cholecystectomy [5]
The port system was coupled to the intestinal wall, fixed by suction and the resection site disinfected
Summary
A reliable and sterile access through the intestinal wall to ease flexible endoscopic transluminal interventions is still appealing but lacks a suitable port system. Methods In a granted industry cooperation, we developed the MIEO-Port, a flexible three components overtube system that provides a temporary hermetic sealing of the intestinal wall to allow endoscopic disinfection and manipulation to gain access to the abdominal cavity. Researchers are no longer focusing on replacing conventional laparoscopic interventions but on developing new principles that offer real advantages to the current standard In this regard, peroral endoscopic myotomy [1] and transanal total mesorectal excision [2] deserve notion as good examples to highlight the potential of transluminal surgery. A safe and reliable technique to penetrate the natural orifice still represents one of the main obstacles and requires, in the colon, technical precautions to prevent infection Since this goal is difficult to achieve in a highly dynamic environment with continuous peristalsis and intestinal fluids passing, primary focus in past years was given to occlusion devices that block. Peritoneal contamination is observed as a constant side effect of transcolonic surgery [13]
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