Gastrostomy port assisted full-thickness gastric resection by using the peroral SurgASSIST introduced via an oroesophageal overtube in a porcine model

Abstract

Background: Intralumenal full-thickness gastric resection (FTGR) could be useful as a biopsy technique or in the management of gastric neoplasms. SurgASSIST is a cutting and stapling device delivered on a steerable shaft to which interchangeable stapling units are affixed.

Objective: This feasibility study assessed the applicability of the SurgASSIST to perform intralumenal FTGR in a swine model.

Design: Descriptive analysis; no statistical tests were applied.

Setting: Animal laboratory.

Methods: Four nonsurvival swine under general anesthesia were studied. An oroesophageal overtube was placed. A balloon trocar was inserted into the stomach under endoscopic guidance and served as a port for instruments and imaging. Under direct visualization, the SurgASSIST with a 55-mm straight-linear cutter and stapler unit (SLCS55) was advanced via the overtube into the stomach. We evaluated the safety and efficacy of overtube placement, SLCS55 insertion and maneuverability in the stomach, parallel versus perpendicular optics, and various tissue grasping devices to achieve FTGR.

Results: Overtube insertion produced limited esophageal mucosal tears in 2 subjects and a severe tear in 1 subject. Maneuverability of the SLCS55 was limited. Endoscopic guidance for FTGR via both peroral (parallel) and per gastrostomy port (perpendicular) orientations was satisfactory. FTGR was successful in 2 of 4 subjects. Resected specimens measured 6.0 x 0.6 cm and 6.0 x 0.7 cm. There were no operative complications. In the remaining 2 subjects, the depth of resection was submucosa.

Limitations: Animal model.

Conclusions: Peroral intralumenal FTGR is feasible. A gastrostomy port facilitates triangulation for optics and tissue manipulation. Further refinements are needed to yield reliable results.