Endoscopic Device Research Articles

Global Surgeon Opinion on the Impact of Surgical Access When Using Endocutters Across Specialties.

Background: Despite design enhancements in endocutters, key challenges related to limited surgical access and space can impact stapling and, potentially, surgical outcomes. Objectives: This study aimed to develop consensus statements outlining the clinical value of precise articulation and greater anatomical access in minimally invasive surgery performed by bariatric, colorectal, and thoracic surgeons. Methods: Colorectal, bariatric, and thoracic surgeons from Japan, the United States, United Kingdom, and France participated in a 2-round modified Delphi panel. Round 1 included binary, Likert scale-type, multiple-response, and open-ended questions. These were converted to affirmative statements for round 2 if sufficient agreement was reached. Consensus was set at a predefined threshold of at least 90% of panelists across all surgical specialties and regions selecting the same option ("agree" or "disagree") for the affirmative statements. Results: Of the 49 statements in the round 2 questionnaire, panelists (n=135) reached consensus that (1) tissue slippage outside stapler jaws can occur due to limited access and space; (2) greater jaw aperture could help to manipulate thick or fragile tissue more easily; (3) articulation of an endocutter is clinically important in laparoscopic surgeries; (4) improved access to hard-to-reach targets and in limited space would improve safety; and (5) an endocutter with improved access through greater articulation would become common use. Discussion: By understanding user-specific challenges and needs from both specialty- and region-wide perspectives, endoscopic stapling devices can continue to be refined. In this study, improved articulation and greater jaw aperture were the key design features examined. Improved articulation and greater jaw aperture were key stapler design features identified in this study that may mitigate the risk of instrument clashes and intraoperative complications such as anastomotic leaks. Conclusions: This study gained insights into surgeons' perspective across a variety of specialties and from 3 distinct geographies. Participating surgeons reached consensus that an endocutter with greater jaw aperture and articulation may improve surgical access and has potential to improve surgical outcomes.

Endoscopic Ruler for varix size measurement: A multicenter pilot study.

We invented Endoscopic Ruler, a new endoscopic device to measure the size of varices in patients with cirrhosis and portal hypertension. To assess the feasibility and safety of Endoscopic Ruler, and evaluate the agreement on identifying large oesophageal varices (OV) between Endoscopic Ruler and the endoscopists, as well as the interobserver agreement on diagnosing large OV using Endoscopic Ruler. We prospectively and consecutively enrolled patients with cirrhosis from 11 hospitals, all of whom got esophagogastroduodenoscopy (EGD) with Endoscopic Ruler. The primary study outcome was a successful measurement of the size of varices using Endoscopic Ruler. The secondary outcomes included adverse events, operation time, the agreement of identifying large OV between the objective measurement of Endoscopic Ruler and the empirical reading of endoscopists, together with the interobserver agreement on diagnosing large OV by Endoscopic Ruler. From November 2020 to April 2022, a total of 120 eligible patients with cirrhosis were recruited and all of them underwent EGD examinations with Endoscopic Ruler successfully without any adverse event. The median operation time of Endoscopic Ruler was 3.00 min [interquartile range (IQR): 3.00 min]. The kappa value between Endoscopic Ruler and the endoscopists while detecting large OV was 0.52, demonstrating a moderate agreement. The kappa value for diagnosing large OV using Endoscopic Ruler among the six independent observers was 0.77, demonstrating a substantial agreement. The data demonstrates that Endoscopic Ruler is feasible and safe for measuring the size of varices in patients with cirrhosis and portal hypertension. Endoscopic Ruler is potential to promote the clinical practice of the two-grade classification system of OV.

Endoscopic Salvage of Gastrointestinal Anastomosis Leaks—Past, Present, and Future—A Narrated Review

Background: Anastomotic leakage, which is defined as a defect in the integrity of a surgical join between two hollow viscera leading to communication between the intraluminal and extraluminal compartments, continues to be of high incidence and one of the most feared complications following gastrointestinal surgery, with a significant potential for a fatal outcome. Surgical options for management are limited and carry a high risk of morbidity and mortality; thus, surgeons are urged to look for alternative options which are minimally invasive, repeatable, non-operative, and do not require general anesthesia. Methods: A narrative review of the international literature took place, including PubMed, Scopus, and Google Scholar, utilizing specific search terms such as “Digestive Surgery AND Anastomotic Leakage OR leak OR dehiscence”. Results: In the present review, we try to describe and analyze the pros and cons of the various endoscopic techniques: from the very first (and still available), fibrin gluing, to endoclip and over-the-scope clip positioning, stent insertion, and the latest suturing and endoluminal vacuum devices. Finally, alongside efforts to improve the existing techniques, we consider stem cell application as well as non-endoscopic, and even endoscopic, attempts at intraluminal microbiome modification, which should ultimately intervene pre-emptively, rather than therapeutically, to prevent leaks. Conclusions: In the last three decades, this search for an ideal device for closure, which must be safe, easy to deploy, inexpensive, robust, effect rapid and stable closure of even large defects, and have a low complication rate, has led to the proposal and application of a number of different endoscopic devices and techniques. However, to date, there is no consensus as to the best. The literature contains reports of only small studies and no randomized trials, failing to take into account both the heterogeneity of leaks and their different anatomical sites.

Major considerations in the use of bariatric endoscopic therapy (intragastric balloon) and nutrological therapy in successful weight loss in patients with obesity: a systematic review

Introduction: Obesity is a chronic and multifactorial disease that affects more than 2.2 billion people worldwide. Treatment options for obesity have expanded significantly and include lifestyle changes, pharmacotherapy, endoscopic bariatric therapies, and bariatric surgery. Objective: It was to carry out a systematic review to present the main considerations regarding the use of the intragastric balloon as bariatric endoscopic therapy and nutritional therapy in an attempt to achieve successful weight loss in patients with obesity. Methods: The PRISMA Platform systematic review rules were followed. The search was carried out from June to August 2023 in the Web of Science, Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: 129 articles were found. A total of 34 articles were evaluated in full and 24 were included in this systematic review. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 26 studies with a high risk of bias and 12 studies that did not meet GRADE. Most studies showed homogeneity in their results, with X2 =74.7% >50%. In the challenges against super obesity and comorbidities, the use of endoscopic devices has been reported for many years, with the majority of positive results for patients. These devices are gaining increasing acceptance, and the Food and Drug Administration (FDA) has approved three endoscopic devices for use. Patients should be carefully assessed nutritionally and medication-wise and advised on the most appropriate route. To promote long-term adherence, any dietary intervention must take into account patients' dietary preferences, cultural context, and food availability. Ideally, use a combination of Mediterranean and high-protein diets to promote weight loss based on the patient's preference.

Endoscopic Retrieval of Esophageal and Gastric Foreign Bodies in Cats and Dogs: A Retrospective Study of 92 Cases.

Esophageal and gastric foreign bodies (FBs) commonly occur in small animal practices, and their endoscopic removal has been previously reported. However, few studies reported the endoscopic instruments used for the retrieval attempt and the time spent for endoscopic removal. Therefore, the aim of this study is to evaluate the factors that can influence the success rate and timing of the endoscopic retrieval of FBs. The medical records of 92 animals undergoing endoscopic removal of esophageal (n = 12) and gastric (n = 84) FBs have been reviewed. Two dogs had FBs in both the esophagus and stomach. From medical records and video recordings, there were extrapolated data on signalment, clinical signs, endoscopic devices used, success of retrieval, and duration of endoscopy. Endoscopic removal of FBs was successful in 88% cases, and the mean time spent for the extraction was 59.74 min (range, 10-120 min). The success rate and timing for the removal of endoscopic foreign bodies (EFBs) are influenced by several factors in our population: medium-breed dogs, adult animals, and localization of FBs in the body of the stomach increased the probability of failure during the endoscopic retrieval attempt. Conversely, the success and timing of the retrieval of EFBs were higher in puppies and with increasing operator's experience. Moreover, the use of combination devices such as polypectomy snare and grasping forceps negatively influenced the success of extraction of FBs. Further prospective and comparative studies in a large and multicentric population of patients can be useful to create interventional endoscopic guidelines, as in human medicine.

Fabrication of Graphene Optical Devices for Endoscope Calibration

Endoscopic devices used in the clinical examination of pathologies such as glottic tumors can record real-time images of the vocal cords during vibration. Quantitative analysis of the glottic surface requires the metric system to obtain the absolute dimensions of the larynx in a series of acquired images. However, so far, there is no effectively automated and stable calibration method for clinical use. Therefore, most metrics used by professionals are invasive and subjective. Thus, this study reports the microfabrication of a diffractive optical element (DOE) that could potentially quantify cancer cells from the glottic surface of patients. It has been observed that the image of the glottis seen through an endoscope is shaped by its geometric properties and by the shading of color and brightness. Therefore, tumor location and size can be quantified by overlaying the DOE metric with light spots on images that include the glottic region. DOE was developed from processes used in the fabrication of integrated circuits and MEMS, already quite mature. To obtain high-quality images from optical reconstruction of the glottis, the use of graphene monolayers grown by chemical vapor deposition (CVD) on copper (Cu) foil was investigated. This was transferred to a glass substrate by wet method (Fishing method) and the etching steps of the Cu substrate were carried out. In this method, polymethylmethacrylate (PMMA) was used as the supporting polymer through the spinner. Two lithographs were made under the glass substrate with different approaches (using a Karl Suss MJB3 mask aligner system with a maximum resolution of 1 µm). The first, which preceded the thin-film transfer, aimed to delineate the graphene transfer area using an aluminum (Al) deposition technique by sputtering. The second lithography, linked to oxygen Ashing plasma corrosion, made it possible to study the modulation of a microrelief containing parallel and serpentine patterns, of amplitude and phase, spaced from 1 to 10 μm. An optical system containing an EOD and a Fourier lens was attached to the endoscope end to project a laser line parallel to the vocal cords. Image processing methods automatically identify pixels in the image data that belong to the projected laser line. Thus, the detection of the diffractive pattern was based on segmentation of endoscopic images centered on Sobel filtering and on the method with active boundary regions of the watershed. These use successively robust temporal and spatial characteristics of the laser lines projected onto the endoscopic image sequence. In short, the combination of laser projection device and image processing allows calibration of endoscopic images and can provide quantitative metric data for tumors on the surface of the vocal cords. Therefore, the proposed calibration method can be considered a powerful tool to aid in the prognosis of laryngeal pathologies. Figure 1

Evaluation of a Clinical Outcome of Resistant Gastroesophageal Reflux Disease after Treatment with Full Thickness Endoscopic Device

Abstract Background Gastroesophageal reflux disease (GERD) is one of the most prevalent gastric disorders, defined as a condition in which reflux of gastric and duodenal contents back into esophagus causing troublesome symptoms and complications impairing quality of life. Objective To evaluate clinical efficacy of endosural suturing using gastroscope for patients with resistant GERD. Subjects and Methods This study is a prospective study. This study was carried out at Gastroenterology outpatient's clinic, endoscopic center of Ain Shams University Hospitals. The study was performed from September 2019 to December 2020. 25 adult patients having resistant GERD or Hiatus hernia. Results In our results we found that there was highly statistically significant difference according to symptoms grade between before treatment and after treatment. In our study we cleared that according to CBC, the mean of Hb 12.89 (± 0.80 SD), the mean of RDW 13.40 (±0.95 SD), the mean of platelets (*1000) 239.76 (± 60.37 SD), mean of RBCs 5.19 (± 0.51 SD). In study in our hands we found that there is highly statistically significant according to hill grade between before treatment and after treatment. Conclusion Our study has shown that endoscopic suturing of the gastroesophageal junction has significant improvements in reflux control that is sustained to 6 months and significant improvement in quality of life after procedure and significant reduction in symptoms severity after procedure.

Evaluation of a Clinical Outcome of Resistant Gastroesophageal Reflux Disease after Treatment with Full Thickness Endoscopic Device

Abstract Introduction The full-thickness Plicator® (Ethicon Endosurgery, Sommerville, NJ, USA) was developed for endoscopic treatment of gastroesophageal reflux disease (GERD). The goal is to restructure the antireflux barrier by delivering transmural pledgeted sutures through the gastric cardia. To date, studies using this device have involved the placement of a single suture to create the plication, Aim of the Work To evaluate clinical efficacy of endosural suturing using gastroscope for patients with resistant GERD, Patients and Methods This is A Prospective study, was carried out on 25 adult patients having resistant GERD or Hiatus hernia at Gastroenterology outpatient's clinic, endoscopic center, From September 2020 to March 2020, Result According to Endoscopy, there were 20 with Esophagitis in found GERD, and 1 case with Incompetent cardia in no GERD finding, Conclusion Endoscopic full-thickness plication using the GERDx™ device improves the distal acid exposure of the esophagus, typical reflux-related symptoms and QoL in well-selected patients. This procedure might constitute an option for patients with mild GERD. Long-term outcomes are required to expand our knowledge on the effects of this procedure,

Flexible endoscopic instrument for diagnosis and treatment of early gastric cancer.

Gastric cancer is a common cancer endangering human life and health worldwide. Early detection and diagnosis of gastric cancer that is normally performed by flexible endoscope can significantly improve the survival rate of patients. However, current endoscopic instruments have some problems, such as limitation of degrees of freedom (DOFs) and lack of surgical triangulation. Meanwhile, the lack of an intraoperative technique for the real-time evaluation of early gastric cancer is also a serious problem. To solve these problems, we have developed a dual-bending flexible endoscopic instrument for the diagnosis and treatment of early gastric cancer. This instrument has a compact structure with a maximum outer diameter of 3mm and an insertion length of 1220mm. It has 5 DOFs with a dual-bending function, which can form a surgical operation triangulation to easily perform the endoscopic procedure. Apart from the surgical forceps, the end of the instrument can be equipped with different endoscopic devices to meet the needs of diagnosis and treatment, such as endomicroscopic probes, electrosurgical knives, and laser ablation optical fibers. It is verified that the instrument can carry these devices to complete corresponding tasks, demonstrating the great potential of this instrument in clinical applications.

Smartphone-Based Rigid Endoscopy Device with Hemodynamic Response Imaging and Laser Speckle Contrast Imaging.

Modern smartphones have been employed as key elements in point-of-care (POC) devices due to remarkable advances in their form factor, computing, and display performances. Recently, we reported a combination of the smartphone with a handheld endoscope using laser speckle contrast imaging (LSCI), suggesting potential for functional POC endoscopy. Here, we extended our work to develop a smartphone-combined multifunctional handheld endoscope using dual-wavelength LSCI. Dual-wavelength LSCI is used to monitor the changes in dynamic blood flow as well as changes in the concentration of oxygenated (HbO2), deoxygenated (Hbr), and total hemoglobin (HbT). The smartphone in the device performs fast acquisition and computation of the raw LSCI data to map the blood perfusion parameters. The flow imaging performance of the proposed device was tested with a tissue-like flow phantom, exhibiting a speckle flow index map representing the blood perfusion. Furthermore, the device was employed to assess the blood perfusion status from an exteriorized intestine model of rat in vivo during and after local ischemia, showing that blood flow and HbO2 gradually decreased in the ischemic region whereas hyperemia and excess increases in HbO2 were observed in the same region right after reperfusion. The results indicate that the combination of LSCI with smartphone endoscopy delivers a valuable platform for better understanding of the functional hemodynamic changes in the vasculatures of the internal organs, which may benefit POC testing for diagnosis and treatment of vascular diseases.

Management of complications related to colorectal endoscopic submucosal dissection.

Compared to endoscopic mucosal resection (EMR), colonoscopic endoscopic submucosal dissection (C-ESD) has the advantages of higher en bloc resection rates and lower recurrence rates of colorectal neoplasms. Therefore, C-ESD is considered an effective treatment method for laterally spread tumors and early colorectal cancer. However, C-ESD is technically more difficult and requires a longer procedure time than EMR. In addition to therapeutic efficacy and procedural difficulty, safety concerns should always be considered when performing C-ESD in clinical practice. Bleeding and perforation are the main adverse events associated with C-ESD and can occur during C-ESD or after the completion of the procedure. Most bleeding associated with C-ESD can be managed endoscopically, even if it occurs during or after the procedure. More recently, most perforations identified during C-ESD can also be managed endoscopically, unless the mural defect is too large to be sutured with endoscopic devices or the patient is hemodynamically unstable. Delayed perforations are quite rare, but they require surgical treatment more frequently than endoscopically identified intraprocedural perforations or radiologically identified immediate postprocedural perforations. Post-ESD coagulation syndrome is a relatively underestimated adverse event, which can mimic localized peritonitis from perforation. Here, we classify and characterize the complications associated with C-ESD and recommend management options for them.

Endocuff Vision-Assisted Resection for Difficult Colonic Lesions-Preliminary Results of a Multicenter, Prospective Randomized Pilot Study.

Background-Screening programs for colorectal cancer are implemented due to their ability to reduce mortality. The Endocuff Vision is a new endoscopic device that significantly improves the adenoma detection rate. The primary outcome was to assess the efficacy of ECV in improving stability and reducing operation time during difficult colon polypectomies in a multicenter randomized prospective study. Methods-In a randomized multicenter pilot study, two groups of patients who underwent difficult polypectomies with and without the assistance of Endocuff Vision were compared. Demographics and clinical characteristics of patients were obtained, and polyps' size, morphology, site, and access (SMSA); polypectomy time; and endoscope stability were evaluated. Results-From October 2016 to April 2020, 32 patients were enrolled. In total, 12 patients underwent Endocuff Vision polypectomy, and 20 patients underwent standard polypectomy by using a computer-generated random number table. No statistical differences were found in clinical characteristics, SMSA, and polypectomy time. The most interesting findings were the positive correlations between shaking and SMSA (r = 0.55, p = 0.005) and shaking and polypectomy time (r = 0.745, p < 0.0001). Conclusion-Endocuff Vision seems to be adequately stable during difficult endoscopic resection procedures. The new parameter proposed that shaking is strongly correlated to the stability of the endoscope, the difficulty of the resection (SMSA), and the polypectomy time.

Deep Learning and Minimally Invasive Endoscopy: Automatic Classification of Pleomorphic Gastric Lesions in Capsule Endoscopy.

Capsule endoscopy (CE) is a minimally invasive examination for evaluating the gastrointestinal tract. However, its diagnostic yield for detecting gastric lesions is suboptimal. Convolutional neural networks (CNNs) are artificial intelligence models with great performance for image analysis. Nonetheless, their role in gastric evaluation by wireless CE (WCE) has not been explored. Our group developed a CNN-based algorithm for the automatic classification of pleomorphic gastric lesions, including vascular lesions (angiectasia, varices, and red spots), protruding lesions, ulcers, and erosions. A total of 12,918 gastric images from 3 different CE devices (PillCam Crohn's; PillCam SB3; OMOM HD CE system) were used from the construction of the CNN: 1,407 from protruding lesions; 994 from ulcers and erosions; 822 from vascular lesions; and 2,851 from hematic residues and the remaining images from normal mucosa. The images were divided into a training (split for three-fold cross-validation) and validation data set. The model's output was compared with a consensus classification by 2 WCE-experienced gastroenterologists. The network's performance was evaluated by its sensitivity, specificity, accuracy, positive predictive value and negative predictive value, and area under the precision-recall curve. The trained CNN had a 97.4% sensitivity; 95.9% specificity; and positive predictive value and negative predictive value of 95.0% and 97.8%, respectively, for gastric lesions, with 96.6% overall accuracy. The CNN had an image processing time of 115 images per second. Our group developed, for the first time, a CNN capable of automatically detecting pleomorphic gastric lesions in both small bowel and colon CE devices.

Direct endoscopic necrosectomy using the novel 5-mm powered endoscopic debridement device: The larger winner?

Video 1Direct endoscopic necrosectomy using the novel 5-mm powered endoscopic debridement device for walled-off pancreatic necrosis, following endoscopic cystogastrostomy with lumen-apposing metal stent.

Effect of Transoral Outlet Reduction on Hepatic Fibrosis in Roux-en-Y Gastric Bypass Patients with Weight Regain and Non-alcoholic Fatty Liver Disease.

Weight regain after Roux-en-Y gastric bypass (RYGB) is associated with worsening of liver outcomes. However, the effect of transoral outlet reduction (TORe) on liver fibrosis in RYGB patients with weight regain and possible advanced fibrosis remains unknown. This was a retrospective analysis of prospectively collected data of RYGB patients who underwent TORe for weight regain. Only patients with possible advanced fibrosis were included. TORe was performed using either an endoscopic suturing device (S-TORe) or plication device (P-TORe) to reduce the gastrojejunal anastomosis (GJA) and pouch sizes. Primary outcomes included changes in non-invasive tests (NITs) for fibrosis at 6-12months. Secondary outcomes included weight loss and changes in insulin resistance and lipid profile at 6-12months. Fifty RYGB patients were included. Baseline age and BMI were 55 ± 11years and 40.1 ± 7.3kg/m2. Baseline GJA and pouch sizes were 20 ± 7mm and 5 ± 2cm, respectively. Thirty patients (60%) underwent S-TORe and 20 patients (40%) underwent P-TORe. At 12months following TORe, there were statistically significant improvements in NITs for fibrosis, including ALT, AST and FIB-4. There was a trend towards significant improvement in liver stiffness measurement on transient elastography. Patients experienced 8.8 ± 11.2% total weight loss (TWL) (p < 0.0001), with 60% experiencing at least 10% TWL. Additionally, there was a significant improvement in HbA1c and a trend toward significant improvement in Homeostatic Model Assessment for Insulin Resistance (HOMA-IR), suggestive of improved insulin sensitivity. TORe is associated with an improvement in hepatic fibrosis in patients with NAFLD and possible advanced fibrosis.

Multiple side-coupled images recognition in plastic optical fibers based on deep learning

In recent years, the technology of multi-mode fiber (MMF) output speckle recognition has been widely used in the fields of optical imaging, endoscope devices, and fiber optic sensor. However, previous studies focused on the single-input transmission mode on a single fiber, which limited the application range of MMF. Meanwhile, the fiber optic sensors based on speckle recognition often lack multiplexing ability. In this paper, multiple lateral sections of plastic optical fiber (POF) are polished, and the images corresponding to 26 letters are coupled into POF form them. When images couple into POF from one lateral polishing section, by analyzing the output speckles based on deep learning technology, the accuracy of speckles recognition with convolution neural network (CNN) reaches over 95% and the structural similarity (SSIM) of reconstructed speckles with U-Net reaches up to 0.96. When two images couple into POF from different lateral polishing sections simultaneously, the output speckle can be reconstructed to the two images respectively, and the average SSIM value for them is 0.95. The experiment proves that the images coupled into fiber through the lateral polishing section of POF can be recognized and reconstructed well by output speckle analysis. This technology can promote the multiplexing ability of the speckles-recognition based fiber sensors or be applied to the field of fiber endoscopes.

1708-P: Comparing 9- vs. 12-Month Implantation in the Worldwide EndoBarrier (EB) Registry

Uncertainty exists re risk: benefit of proximal intestinal exclusion with EB, a novel endoscopic duodenal jejunal liner device for obesity, both with and without diabetes. In view of this, during 2017, an independent, secure, on line registry was established under the auspices of the Association of British Clinical Diabetologists, for the collection of safety and efficacy data worldwide. As of December 2022, data had been entered on 1022 patients, of whom 195 (age 51.6±10.3 years, 53% male, 81% white ethnicity, BMI 39.9±6.9kg/m2) had both 9- and 12-month data entered. EB had considerable impact on weight and HbA1c (Table). There was no difference between the mean±SD reduction in HbA1c or weight at 9- vs 12-months (HbA1c: 1.39±1.67% vs 1.38±1.66% (p=0.98); weight: 11.7±8.3kg vs 12.0±8.3kg (p=0.44). The higher the HbA1c the greater the fall but again no difference between 9- and 12-months (Table). In the full registry, 43/1022 (4.2%) experienced serious adverse events (SAE). 15/43 (34.9%) SAE would have been avoided by removal at 9-months (9 liver abscess, 4 GI bleed, one cholecystitis). It was particularly noteworthy that 9/13 (69.2%) liver abscess SAEs would have been avoided by removal at 9-months. This international data from the EB registry suggests that the benefits of EB are achieved in 9-months and a reduction in the recommended implantation period from 12- to 9-months would reduce SAEs, especially the liver abscess SAE. Disclosure R.E.Ryder: Other Relationship; Novo Nordisk, Speaker's Bureau; GI Dynamics, BioQuest. J.J.Mcmaster: None. J.Chisholm: None. L.Kow: None. J.C.Mason: None. R.V.Cohen: Advisory Panel; GI Dynamics, Research Support; Medtronic, Johnson &amp; Johnson Medical Devices Companies. P.Sen gupta: Other Relationship; Novo Nordisk. M.Yadagiri: None. L.Munro: None. H.Frydenberg: None. S.Fishman: None. J.P.Byrne: Advisory Panel; Oxford Medical Products, Join Embla, Stock/Shareholder; Join Embla. J.P.Teare: None. C.De jonge: None. J.Greve: Advisory Panel; GI Dynamics. Funding Association of British Clinical Diabetologists

Transparent Pneumatic Tactile Sensors for Soft Biomedical Robotics

Palpation is a simple but effective method to distinguish tumors from healthy tissues. The development of miniaturized tactile sensors embedded on endoscopic or robotic devices is key to achieving precise palpation diagnosis and subsequent timely treatment. This paper reports on the fabrication and characterization of a novel tactile sensor with mechanical flexibility and optical transparency that can be easily mounted on soft surgical endoscopes and robotics. By utilizing the pneumatic sensing mechanism, the sensor offers a high sensitivity of 1.25 mbar and negligible hysteresis, enabling the detection of phantom tissues with different stiffnesses ranging from 0 to 2.5 MPa. Our configuration, combining pneumatic sensing and hydraulic actuating, also eliminates electrical wiring from the functional elements located at the robot end-effector, thereby enhancing the system safety. The optical transparency path in the sensors together with its mechanical sensing capability open interesting possibilities in the early detection of solid tumor as well as in the development of all-in-one soft surgical robots that can perform visual/mechanical feedback and optical therapy.

Measuring thermal spread during bipolar cauterizing using an experimental pneumoperitoneum and thermal sensors.

During nerve-sparing robot-assisted radical prostatectomy (RARP) bipolar electrocoagulation is often used but its use is controversial for the possible thermal damage of neurovascular bundles. Aim of the study was to evaluate the spatial-temporal thermal distribution in the tissue and the correlation with the electrosurgery-induced tissue damage in a controlled, CO2-rich environment modelling the laparoscopy conditions.. We manufactured a sealed plexiglass chamber (SPC) equipped with sensors to reproduce experimentally the environmental conditions of pneumoperitoneum during RARP. We evaluated in 64 pig musculofascial tissues (PMTs) of approximately 3 cm3 × 3 cm3 × 2 cm3 the spatial-temporal thermal distribution in the tissue and the correlation with the electrosurgery-induced tissue damage in a controlled CO2-rich environment modeling the laparoscopy conditions. Critical heat spread of bipolar cauterizing during surgical procedure was assessed by the employment of a compact thermal camera (C2) with a small core sensor (60 × 80 microbolometer array in the range 7-14 μm). Bipolar instruments used at 30 W showed a thermal spread area of 18 mm2 when applied for 2 s and 28 mm2 when applied for 4 s. At 60 W, bipolar instruments showed a mean thermal spread and 19 mm2 when applied for 2 s; and 21 mm2 when applied for 4 s. Finally, histopathological analysis showed that thermal damage is distributed predominantly on the surface rather than in depth. The application of these results is very interesting for the definition of an accurate use of bipolar cautery during nerve-sparing RARP. It demonstrates the feasibility of using miniaturized thermal sensors, thus addressing the potential for next developments regarding the design of thermal endoscopic devices for robotic use.

Technical Review on Endoscopic Treatment Devices for Management of Upper Gastrointestinal Postsurgical Leaks.

Upper gastrointestinal postsurgical leaks are challenging to manage and often require radiological, endoscopic, or surgical intervention. Nowadays, endoscopy is considered the first-line approach for their management, however, there is no definite consensus on the most appropriate therapeutic approach. There is a wide diversity of endoscopic options, from close-cover-divert approaches to active or passive internal drainage approaches. Theoretically, all these options can be used alone or with a multimodality approach, as each of them has different mechanisms of action. The approach to postsurgical leaks should always be tailored to each patient, taking into account the several variables that may influence the final outcome. In this review, we discuss the important developments in endoscopic devices for the treatment of postsurgical leaks. Our discussion specifically focuses on principles and mechanism of action, advantages and disadvantages of each technique, indications, clinical success, and adverse events. An algorithm for endoscopic approach is proposed.