Endoluminal Endoluminal Closure DeviceClosure Device

Braham DhillonBraham DhillonAli HalesAli Hales

Laura MattalianoLaura MattalianoJohn SticklenJohn Sticklen

Abdominal SurgeryAbdominal Surgery

Most surgeries in the peritoneal cavity currently Most surgeries in the peritoneal cavity currently require incision through the abdomenrequire incision through the abdomen

New development: Natural Orifice New development: Natural Orifice Transluminal Endoscopic Surgery (NOTES)Transluminal Endoscopic Surgery (NOTES)

NOTES – Using an endoscope, create a hole NOTES – Using an endoscope, create a hole in the stomach wall (gastrotomy) to gain in the stomach wall (gastrotomy) to gain access to peritoneal cavity to perform surgeryaccess to peritoneal cavity to perform surgery

Our ProjectOur Project

Problem: Currently there is no way to Problem: Currently there is no way to reliably seal the gastrotomy.reliably seal the gastrotomy.

Objective: Develop a device to close a Objective: Develop a device to close a gastrotomy after a NOTES procedure – gastrotomy after a NOTES procedure – stitch, clamp, staple or otherwise sealstitch, clamp, staple or otherwise seal

Benefits: incisionless surgeries, quicker Benefits: incisionless surgeries, quicker recovery time (??) recovery time (??)

AdvisersAdvisers

Mike Holzman, M.D., M.P.H.Mike Holzman, M.D., M.P.H.Gastrointestinal surgery, laparoscopic Gastrointestinal surgery, laparoscopic proceduresprocedures

Gus Attwell, M.D.Gus Attwell, M.D.general gastroenterologygeneral gastroenterology

Alan Herline, M.D.Alan Herline, M.D.colo rectal surgerycolo rectal surgery

The StomachThe Stomach An external systemAn external system

Digestion of foodDigestion of food A lot of acid and pepsinA lot of acid and pepsin

11stst layer: thick layer of mucus layer: thick layer of mucus 22ndnd layer: antacid bicarbonate layer: antacid bicarbonate

33rdrd layer: tight cell surface and folds layer: tight cell surface and folds

Perforation: hole in stomachPerforation: hole in stomach Severe pain, shock & hardening of wallSevere pain, shock & hardening of wall Bleeding into digestive tract Bleeding into digestive tract

Reference: http://www.yourdictionary.com/images/ahd/jpg/A4stomac.jpg

GastroscopeGastroscope A long, thin, flexible fiber optic tube A long, thin, flexible fiber optic tube

with light and a camera attached with light and a camera attached Used to examine the lining of the Used to examine the lining of the

upper GI tractupper GI tract Diagnosis and treatment of Diagnosis and treatment of

-bleeding-bleeding

-cancers -cancers

-hiatal hernia-hiatal hernia

-removal of swallowed -removal of swallowed objectsobjects

-abnormalities -abnormalities Biopsy taken with miniature foreceps Biopsy taken with miniature foreceps

or thin wire-loop snare or thin wire-loop snare

Reference: http://www.gihealth.com/html/test/gastroscopy.html

LaparoscopeLaparoscope A slender tubular endoscopeA slender tubular endoscope Used to look at a patients Used to look at a patients

abdomen or pelvis (appendix, abdomen or pelvis (appendix, liver, gallbladder, fallopian tubes, liver, gallbladder, fallopian tubes, ovaries etc)ovaries etc)

Small incision though which Small incision though which probes and other instruments are probes and other instruments are introduced. introduced.

Smaller incisions, faster recovery Smaller incisions, faster recovery time, cost effective, less risky.time, cost effective, less risky.

Reference: http://www.nlm.nih.gov/medlineplus/ency/imagepages/1109.htm

Current AccomplishmentsCurrent Accomplishments

Meetings with Dr. HolzmanMeetings with Dr. Holzman Parameters of IncisionParameters of Incision

2 cm length, Stomach wall thickness 3-5 mm2 cm length, Stomach wall thickness 3-5 mm Heal within 7-14 daysHeal within 7-14 days

Current and Potential methodsCurrent and Potential methods VideosVideos

Endoscopic SurgeryEndoscopic Surgery Potential SolutionsPotential Solutions

Observation of Hernia SurgeryObservation of Hernia Surgery Examination of EquipmentExamination of Equipment Preliminary ResearchPreliminary Research

Current PlanCurrent Plan

December 6December 6thth – Meet with Dr. Attwell – Meet with Dr. Attwell EndoscopeEndoscope

With CAD drawingsWith CAD drawings Requested in DecemberRequested in December

GI MentorGI Mentor Dr. Caroline CaoDr. Caroline Cao Virtual reality program, simulates gastrointestinal Virtual reality program, simulates gastrointestinal

systemsystem Currently discussing appointment timesCurrently discussing appointment times

Future PlansFuture Plans

Explore the feasibility of using materials Explore the feasibility of using materials with “shape memory” with “shape memory”

- Nitinol - Nitinol

- Thermoplastic polymers - Thermoplastic polymers Determine methods of testing procedureDetermine methods of testing procedure

- Materials with properties of stomach- Materials with properties of stomach

- Testing on animal stomachs- Testing on animal stomachs

NitinolNitinol

Equal mixture of Equal mixture of nickel and titaniumnickel and titanium

Shape of material Shape of material dependent on dependent on temperature temperature

Coil Coil Push through Push through

Thermoplastic PolymerThermoplastic Polymer

Has been shown to tie itself into a knotHas been shown to tie itself into a knot Absorbed by the bodyAbsorbed by the body Engineered to retain memory of specific Engineered to retain memory of specific

shapeshape Transforms into that shape when heated Transforms into that shape when heated

to body temperatureto body temperature Polymers that respond to UV light Polymers that respond to UV light

QuestionsQuestions