BACKGROUND Endoscopic treatment of pancreatic necrosis can be challenging and timeconsuming because sticky necrotic debris is sometimes difficult to remove. The over-the-scope-grasper, a new tool that has recently bec...BACKGROUND Endoscopic treatment of pancreatic necrosis can be challenging and timeconsuming because sticky necrotic debris is sometimes difficult to remove. The over-the-scope-grasper, a new tool that has recently become available for this purpose, might also be useful for other indications. However, clinical data on the efficacy and safety of this new device are lacking.AIM To evaluate the technical success and safety of the device in a multicenter setting.METHODS The over-the-scope-grasper was used in nine selected endoscopic centers between November 2020and October 2021 for appropriate indications. Overall, 56 procedures were included in the study.We retrospectively evaluated procedural parameters of all endoscopic interventions using a predefined questionnaire, with special respect to technical success, indications, duration of intervention, type of sedation, and complications. In the case of pancreatic necrosectomy, the access route, stent type, number of necrosis pieces removed, and clinical handling were also recorded.RESULTS A total of 56 procedures were performed, with an overall technical success rate of 98%. Most of the procedures were endoscopic pancreatic necrosectomies(33 transgastric, 4 transduodenal). In 70%of the procedures, access to the necrotic cavity was established with a lumen apposing metal stent.The technical success of pancreatic necrosectomy was 97%, with a mean of 8 pieces(range, 2-25pieces) of necrosis removed in a mean procedure time of 59 min(range, 15-120 min). In addition,the device has been used to remove blood clots(n = 6), to clear insufficiency cavities before endoluminal vacuum therapy(n = 5), and to remove foreign bodies from the upper gastrointestinal tract(n = 8). In these cases, the technical success rate was 100%. No moderate or severe/fatal complications were reported in any of the 56 procedures.CONCLUSION These first multicenter data demonstrate that the over-the-scope-grasper is a promising device for endoscopic pancreatic necrosectomy, which is also appropriate for removing foreign bodies and blood clots, or cleaning insufficiency cavities prior to endoluminal vacuum therapy.展开更多
AIM:To evaluate the efficacy and safety of grasper type scissors(GTS)for endoscopic submucosal dissection(ESD)of gastric epithelial neoplasia.METHODS:The study was performed by 4 endoscopists in 4 institutions affilia...AIM:To evaluate the efficacy and safety of grasper type scissors(GTS)for endoscopic submucosal dissection(ESD)of gastric epithelial neoplasia.METHODS:The study was performed by 4 endoscopists in 4 institutions affiliated to The Catholic University of Korea.ESD was performed in 76 consecutive patients with gastric epithelial neoplasia by using the GTS(37 patients)or the hook knife plus coagrasper(HKC)(39 patients).The complete resection rate,complication rate,total time elapsed and elapsed time per square centimeter of the dissected specimen were analyzed between the GTS and HKC group.RESULTS:The mean age of the GTS group was 62.3±11.4 years and mean age of the HKC group was 65.6±10.1 years.Differentiated adenocarcinoma was found in32.4%in the GTS group and 33.3%in the HKC group.The procedures were performed without interruption in every case in both groups.The en bloc resection rates of both groups were 100%.The total time elapsed during the procedure was 44.54±21.72 min in the GTS group and 43.77±21.84 min in the HKC group(P=0.88)and the time elapsed per square centimeter of the resected lesion was 7.53±6.35 min/cm2in the GTS group and 6.92±5.93 min/cm2in the HKC group(P=0.66).The overall complication rate was not significantly different between the two groups.CONCLUSION:GTS is a safe and effective device for ESD compared with HKC.ESD can be performed with GTS alone,which can reduce the costs for ESD.展开更多
Background: In order to develop new and better laparoscopic bowel instruments, which reduces patient risks, the opinions and experience that surgeons have with current laparoscopic bowel grasper haptics is important. ...Background: In order to develop new and better laparoscopic bowel instruments, which reduces patient risks, the opinions and experience that surgeons have with current laparoscopic bowel grasper haptics is important. In this study we explored this by means of a questionnaire. Method: A total of 386 online- questionnaires, were sent to laparoscopic surgeons working in European hospitals. They were all members of the European Association of Endoscopic Surgery and perform laparoscopic obesities or bowel surgery. Surgeons where divided into different age and experience groups. Results: A total of 174 completely filled out forms were analyzed. In total, 16% of the surgeons cannot prevent damage when they pinch too hard, although they (10%) might have seen or felt it. Seven percent of the respondents were not able to see or feel tissue slippage. Whereas 31% can see or feel slippage they cannot do anything to prevent it. Overall, most of the respondents would appreciate technical changes in the laparoscopic bowel graspers to reduce tissue damage. Of all the respondents, 79% maintain that it is necessary to have a new laparoscopic grasper with augmented feedback. The majority of the respondents (77%) would like to have tactile feedback as an indication of the level of pinch force. There are not many differences in the opinions of surgeons at different skill levels. Conclusion: From the results of the questionnaire and the other comments made by respondents it is evident that research and developments in the field of new laparoscopic graspers should continue.展开更多
A 9-year-old girl presented with a chief complaint of abdominal pain. Esophagogastroduodenal endoscopy (EGD) identifi ed a long and large gastric trichobezoar extending into the duodenum. We attempted endoscopic retri...A 9-year-old girl presented with a chief complaint of abdominal pain. Esophagogastroduodenal endoscopy (EGD) identifi ed a long and large gastric trichobezoar extending into the duodenum. We attempted endoscopic retrieval after informed consent was obtained from the patient's mother. Initially, a gasper with 5-prolongs, com monly used for retrieval of endoscopically excised poly ps, failed to remove the whole trichobezoar. When a net was used instead, it proved impossible to remove the trichobezoar completely. Therefore, we withdrew the scope from the mouth, leaving the net grasping the tri co bezoar firmly in the stomach. Subsequently, we were able to retrieve about 70% of the trichobezoar manually by grasping the snare part of the net directly. A second pass found no deep laceration or perforation endoscopically. The remaining trichobezoar was completely retrieved with the net. The procedure was completed within 15 min. The retrieved specimens were34 cm in length and 100 g in weight. The patient was discharged uneventfully 5 d thereafter. She was advised to visit a psychiatrist to avoid suffering from a relapse. Follow-up EGD showed no trichobezoar, and the patient' s frontal hair grew back.展开更多
This paper reports the design and fabrication of a MEMS-based ZnO piezoelectric tactile sensor,which can be integrated on to the endoscopic grasper used in minimally invasive surgery (MIS).The sensor includes a silico...This paper reports the design and fabrication of a MEMS-based ZnO piezoelectric tactile sensor,which can be integrated on to the endoscopic grasper used in minimally invasive surgery (MIS).The sensor includes a silicon substrate, platinum bottom electrode,platinum top electrode,and a ZnO piezoelectric thin film,which is sandwiched between the two-electrode layers.The sensitivity of the micro-force sensor is analyzed in theory and the sensor exhibits high sensitivity about 7pc/uN.The application of this tactile sensor to MIS will allow the surgeon feeling the touch force between the endoscopic grasper and tissue in real-time,and manipulating the tissue safely.展开更多
Laparoscopic surgery is a new abdominal surgical procedure which helps the patients in many ways like less hospital stay, faster recovery and reduced pain. The main disadvantage in this surgical procedure is the reduc...Laparoscopic surgery is a new abdominal surgical procedure which helps the patients in many ways like less hospital stay, faster recovery and reduced pain. The main disadvantage in this surgical procedure is the reduced haptic perception by the surgeons due to the usage of laparoscopic instrument to handle tissues which in turn cause damage of it as compared to an open surgery. The primary aim of this investigation was to compare the pinch force applied during two different methods of laparoscopic grasping: Finger and Palm grasp. A low cost force sensing resistor tailor made for the grasper tip was designed and fabricated for quantifying the grasper tip force in the study. The results indicate more pinch force was applied during palm grasp as compared to finger grasp so as to prevent the slippage of the tissues from the jaws of the laparoscopic graspers.展开更多
Purpose: Peritoneal resection for the therapy of oncological diseases as well as endometriosis is associated with major problems as injury to neighboring organs and difficulties in the establishment of the necessary h...Purpose: Peritoneal resection for the therapy of oncological diseases as well as endometriosis is associated with major problems as injury to neighboring organs and difficulties in the establishment of the necessary hemostasis. In this paper we present a new dissection tool, the “Jet Grasper” (KARL STORZ?), which represents a further step towards simple, safe and effective laparoscopic peritoneal resection. Methods: The “Jet Grasper”, was developed to enable selective dissection of the peritoneum and, if necessary, other organs in the case of adhesions. For the tissue resection different techniques can be applied (e.g. ultrasound, mechanical or electrosurgical energy). Results: The tool features a dissection forceps with a narrow slit at the end of the jaw. Further selective dissection is achieved by applying water pressure retroperitoneally via a controlled water pressure pump. Furthermore a diameter difference between the jaw and the sheath potentiates dissection. The thin jaws are introduced precisely to separate and/or dissect layers in a physiological manner to enable further dissection of the peritoneum at a safe distance. Larger vessels can subsequently be targeted for bipolar coagulation in the opened retroperitoneal area. As we are exclusively presenting a completely new device, no patient data are included here. However, a prospective randomized study already started in April 2012, and will be reported after completion in two years. Conlusion: The new dissection tool combines selective dissection and resection under controlled water pressure, known from aquadissection. It provides enhanced and atraumatic possibilities in performing pelvic peritoneal resection via selective dissection and reduction of blood loss.展开更多
文摘BACKGROUND Endoscopic treatment of pancreatic necrosis can be challenging and timeconsuming because sticky necrotic debris is sometimes difficult to remove. The over-the-scope-grasper, a new tool that has recently become available for this purpose, might also be useful for other indications. However, clinical data on the efficacy and safety of this new device are lacking.AIM To evaluate the technical success and safety of the device in a multicenter setting.METHODS The over-the-scope-grasper was used in nine selected endoscopic centers between November 2020and October 2021 for appropriate indications. Overall, 56 procedures were included in the study.We retrospectively evaluated procedural parameters of all endoscopic interventions using a predefined questionnaire, with special respect to technical success, indications, duration of intervention, type of sedation, and complications. In the case of pancreatic necrosectomy, the access route, stent type, number of necrosis pieces removed, and clinical handling were also recorded.RESULTS A total of 56 procedures were performed, with an overall technical success rate of 98%. Most of the procedures were endoscopic pancreatic necrosectomies(33 transgastric, 4 transduodenal). In 70%of the procedures, access to the necrotic cavity was established with a lumen apposing metal stent.The technical success of pancreatic necrosectomy was 97%, with a mean of 8 pieces(range, 2-25pieces) of necrosis removed in a mean procedure time of 59 min(range, 15-120 min). In addition,the device has been used to remove blood clots(n = 6), to clear insufficiency cavities before endoluminal vacuum therapy(n = 5), and to remove foreign bodies from the upper gastrointestinal tract(n = 8). In these cases, the technical success rate was 100%. No moderate or severe/fatal complications were reported in any of the 56 procedures.CONCLUSION These first multicenter data demonstrate that the over-the-scope-grasper is a promising device for endoscopic pancreatic necrosectomy, which is also appropriate for removing foreign bodies and blood clots, or cleaning insufficiency cavities prior to endoluminal vacuum therapy.
基金Supported by Research grants from Korean Society of Gastrointestinal Endoscopy
文摘AIM:To evaluate the efficacy and safety of grasper type scissors(GTS)for endoscopic submucosal dissection(ESD)of gastric epithelial neoplasia.METHODS:The study was performed by 4 endoscopists in 4 institutions affiliated to The Catholic University of Korea.ESD was performed in 76 consecutive patients with gastric epithelial neoplasia by using the GTS(37 patients)or the hook knife plus coagrasper(HKC)(39 patients).The complete resection rate,complication rate,total time elapsed and elapsed time per square centimeter of the dissected specimen were analyzed between the GTS and HKC group.RESULTS:The mean age of the GTS group was 62.3±11.4 years and mean age of the HKC group was 65.6±10.1 years.Differentiated adenocarcinoma was found in32.4%in the GTS group and 33.3%in the HKC group.The procedures were performed without interruption in every case in both groups.The en bloc resection rates of both groups were 100%.The total time elapsed during the procedure was 44.54±21.72 min in the GTS group and 43.77±21.84 min in the HKC group(P=0.88)and the time elapsed per square centimeter of the resected lesion was 7.53±6.35 min/cm2in the GTS group and 6.92±5.93 min/cm2in the HKC group(P=0.66).The overall complication rate was not significantly different between the two groups.CONCLUSION:GTS is a safe and effective device for ESD compared with HKC.ESD can be performed with GTS alone,which can reduce the costs for ESD.
文摘Background: In order to develop new and better laparoscopic bowel instruments, which reduces patient risks, the opinions and experience that surgeons have with current laparoscopic bowel grasper haptics is important. In this study we explored this by means of a questionnaire. Method: A total of 386 online- questionnaires, were sent to laparoscopic surgeons working in European hospitals. They were all members of the European Association of Endoscopic Surgery and perform laparoscopic obesities or bowel surgery. Surgeons where divided into different age and experience groups. Results: A total of 174 completely filled out forms were analyzed. In total, 16% of the surgeons cannot prevent damage when they pinch too hard, although they (10%) might have seen or felt it. Seven percent of the respondents were not able to see or feel tissue slippage. Whereas 31% can see or feel slippage they cannot do anything to prevent it. Overall, most of the respondents would appreciate technical changes in the laparoscopic bowel graspers to reduce tissue damage. Of all the respondents, 79% maintain that it is necessary to have a new laparoscopic grasper with augmented feedback. The majority of the respondents (77%) would like to have tactile feedback as an indication of the level of pinch force. There are not many differences in the opinions of surgeons at different skill levels. Conclusion: From the results of the questionnaire and the other comments made by respondents it is evident that research and developments in the field of new laparoscopic graspers should continue.
文摘A 9-year-old girl presented with a chief complaint of abdominal pain. Esophagogastroduodenal endoscopy (EGD) identifi ed a long and large gastric trichobezoar extending into the duodenum. We attempted endoscopic retrieval after informed consent was obtained from the patient's mother. Initially, a gasper with 5-prolongs, com monly used for retrieval of endoscopically excised poly ps, failed to remove the whole trichobezoar. When a net was used instead, it proved impossible to remove the trichobezoar completely. Therefore, we withdrew the scope from the mouth, leaving the net grasping the tri co bezoar firmly in the stomach. Subsequently, we were able to retrieve about 70% of the trichobezoar manually by grasping the snare part of the net directly. A second pass found no deep laceration or perforation endoscopically. The remaining trichobezoar was completely retrieved with the net. The procedure was completed within 15 min. The retrieved specimens were34 cm in length and 100 g in weight. The patient was discharged uneventfully 5 d thereafter. She was advised to visit a psychiatrist to avoid suffering from a relapse. Follow-up EGD showed no trichobezoar, and the patient' s frontal hair grew back.
基金supported by National Natural Science Foundation of China(No.90207003)
文摘This paper reports the design and fabrication of a MEMS-based ZnO piezoelectric tactile sensor,which can be integrated on to the endoscopic grasper used in minimally invasive surgery (MIS).The sensor includes a silicon substrate, platinum bottom electrode,platinum top electrode,and a ZnO piezoelectric thin film,which is sandwiched between the two-electrode layers.The sensitivity of the micro-force sensor is analyzed in theory and the sensor exhibits high sensitivity about 7pc/uN.The application of this tactile sensor to MIS will allow the surgeon feeling the touch force between the endoscopic grasper and tissue in real-time,and manipulating the tissue safely.
文摘Laparoscopic surgery is a new abdominal surgical procedure which helps the patients in many ways like less hospital stay, faster recovery and reduced pain. The main disadvantage in this surgical procedure is the reduced haptic perception by the surgeons due to the usage of laparoscopic instrument to handle tissues which in turn cause damage of it as compared to an open surgery. The primary aim of this investigation was to compare the pinch force applied during two different methods of laparoscopic grasping: Finger and Palm grasp. A low cost force sensing resistor tailor made for the grasper tip was designed and fabricated for quantifying the grasper tip force in the study. The results indicate more pinch force was applied during palm grasp as compared to finger grasp so as to prevent the slippage of the tissues from the jaws of the laparoscopic graspers.
文摘Purpose: Peritoneal resection for the therapy of oncological diseases as well as endometriosis is associated with major problems as injury to neighboring organs and difficulties in the establishment of the necessary hemostasis. In this paper we present a new dissection tool, the “Jet Grasper” (KARL STORZ?), which represents a further step towards simple, safe and effective laparoscopic peritoneal resection. Methods: The “Jet Grasper”, was developed to enable selective dissection of the peritoneum and, if necessary, other organs in the case of adhesions. For the tissue resection different techniques can be applied (e.g. ultrasound, mechanical or electrosurgical energy). Results: The tool features a dissection forceps with a narrow slit at the end of the jaw. Further selective dissection is achieved by applying water pressure retroperitoneally via a controlled water pressure pump. Furthermore a diameter difference between the jaw and the sheath potentiates dissection. The thin jaws are introduced precisely to separate and/or dissect layers in a physiological manner to enable further dissection of the peritoneum at a safe distance. Larger vessels can subsequently be targeted for bipolar coagulation in the opened retroperitoneal area. As we are exclusively presenting a completely new device, no patient data are included here. However, a prospective randomized study already started in April 2012, and will be reported after completion in two years. Conlusion: The new dissection tool combines selective dissection and resection under controlled water pressure, known from aquadissection. It provides enhanced and atraumatic possibilities in performing pelvic peritoneal resection via selective dissection and reduction of blood loss.
