2005 SAGES Abstracts

EMERGING TECHNOLOGY LUNCH ORAL ABSTRACTS
SAGES 2005
and has limited precision of efficacy. Drugs only inhibit acid
production; they do not address the physiologic dysfunction of
the LES. Opportunity remains for a comprehensive treatment
which is minimally invasive, safe and restores the LES to normal
function. Our approach is to correct the LES by providing
an implant to directly augment its function. It is our objective
that this implant provides a precise pressure barrier in the
LES. It is our further objective that the implant can actuate to
allow normal swallow functions.
The technology is an active implant which is attached to the
distal esophagus. The implant provides a barrier to gastric
pressures, yet yields to normal swallow pressures.
At rest the implant provides a compressive resistance to opening
of the esophagus with a magnitude of 10-20mm Hg.
When swallowing, the implant?s resting tone barrier decreases.
This allows the implant to distend to the maximum diameter
of the esophagus and immediately return to the minimum
diameter of the esophagus after the food bolus passes.
The device has been extensively tested in animal studies both
acutely and chronically. All animals have undergone pre- and
post-implant manometry testing which consistently yields an
average 15 mm-Hg pressure increase over baseline.
Fluoroscopically viewed barium swallows were also performed
to verify normal swallow function and device actuations; all
have been normal. Additionally, histopathology assessment
has demonstrated a stable healing process and incorporation
of the implant.
Pre-clinical testing of the device is being completed. The
implant provides a definitive and physiologic increase in pressure
resistance to gastric reflux. To date, data suggests the
implant is safely incorporated to the esophagus and maintains
its position. Additionally, the implant?s function of providing a
gastric pressure barrier and allowing full distention for normal
swallow function appears permanent.
ET005
MULTISPECTRAL THERAPEUTIC ENDOSCOPY—IMAGING
AND INTERVENTION, John L Bala BS, Ronald Franzino MD,
Micro Invasive Technology, Inc.
OBJECTIVES: This paper’s objective is to redefine conventional
endoscopes so that they can efficiently transmit Visible (VIS),
Ultra Violet (UV) and Infrared (IR) images from within the
body, and can guide laser energy into it.
DESCRIPTION: Current endoscopes cannot combine visual
imaging and therapeutic intervention because their light
source is static; their fiber optic bandwidth is limited; and their
optics are inefficient, responding only to light between 400-
700nm. The multispectral endoscope uses Pulsed Xenon
Flashtubes which offer a broad optical spectrum (190-1200nm),
and which generate high-powered micro-second light pulses
that convert non-visible light into visual images. These images
can become visible with the use of photodynamic dyes or IR
Sensors. Multiplexing technology can also direct lasers for
ablation/coagulation by sharing the fiber optic illumination
pathway into the body between intervention and imaging.
Pulsed Xenon’s UV output can directly kill some infectious
bacteria in seconds and also activate diagnostic dyes in situ.
During laser surgery, this technology can also identify thermal
variations in solid tissue temperature; the IR spectrum may be
able to delineate solid tissue from blood vessels as well.
The multispectral endoscope uses optical concepts that
replace up to 22 optical elements with a single component to
increase the transfer efficiency and resolution of visual and IR
images. It can be equipped with different, interchangeable,
low-cost, disposable illuminators which can be optimized for a
given surgical procedure.
RESULTS: Working prototypes of the “Pulsed Xenon Imaging
and Intervention System “ demonstrate the efficacy of multiplexing.
Laboratory tests utilized pulsed UV light to kill
238 http://www.sages.org/
Staphylococcus. In vivo tests demonstrated multiplexing of
lasers with visual imaging. Image-guided intestinal biopsies
using a disposable illuminator multispectral endoscope integrated
with a snare were performed.
CONCLUSIONS/FUTURE DIRECTION: Current results represent
“proof of concept” rather than FDA clinical test requirements.
These results demonstrate the multispectral endoscope’s
potential as a therapeutic surgical imaging device. Integrating
laser targeting with visual imaging will further increase the
capability of both technologies. Multispectral imaging and
intervention, combined with application-based optics, is the
enabling technology for the future of endoscopy.
ET006
NICKEL TITANIUM (NITI) CLIP FOR SIDE-TO-SIDE BOWEL
COMPRESSION ANASTOMOSIS. PRELIMINARY RESULTS IN
HUMANS., Amir Szold MD, Doron Kopelman MD,Shlomo
Lelcuk MD, Tel Aviv Sourasky Medical Center, Ha’emek
Medical Center, Rabin Medical Center
Aim: NiTi is a Shape-memory alloy with unique physical properties.
These properties were used to design a device for sideto-side
bowel anastomosis. After preliminary testing in animals
proved safety and efficacy, and after a feasibility proof of
concept in limited number of humans, the device was first
used in humans over the past year.
Methods: The device consists of a double coil inserted sideways
into the two bowel loops to be anastomosed, through
small incisions. A deployment instrument inserts the device
and creates a small slit between the bowel loops to allow passage
of gas and fluids until the anastomosis is patent. The clip
has memory shape; it is inserted after cooling, allowing
spreading of the coil for easy introduction and after warming
to body temperature it closes over the tissue in constant and
controlled force. During 5-10 days following the procedure the
clip compresses the bowel loops. Pressure necrosis and fibrosis
that take place simultaneously create a healed anastomosis
within that time period, and the device detaches and is
expelled naturally.
Results: Following animal studies the device was used in over
60 patients for the creation of small bowel and large bowel
anastomoses. Following some design adjustments the device
was found to be easy to use, and effective. There were no
adverse effects attributable to the device, and the anastomoses
functioned within 3-6 days following the operation.
Conclusions: The NiTi device was found to be safe and effective.
A large, multi-center is currently undertaken to further
study the use of this side-to-side compression Anastomosis
device.
ET007
DEPLOYMENT & EARLY EXPERIENCE WITH REMOTE PRES-
ENCE ROBOTIC-ASSISTED PATIENT CARE IN A COMMUNITY
HOSPITAL, Joseph B Petelin MD, Jonathan Goodman MD,
Surgix Minimally Invasive Surgery Institute, Univ of Kansas
School of Medicine Dept of Surgery
Introduction: Telemedicine has been discussed for decades.
The widespread implementation of a remote true patientphysician
interaction has awaited useful devices, adequate
communication bandwidth, and protocols that would make it
practical. The introduction of the RP-6? (InTouch Health, Santa
Barbara) remote presence ?robot? appears to be a useful
telemedicine device. The authors describe the deployment and
early experience with the RP-6? in a community hospital, and
provide a live demonstration of the system.
Methods: The RP6? is a 5?4? tall, 215 pound robot that can be
remotely controlled from an appropriately configured computer
located anywhere on the Internet (i.e. this planet). The system
is composed of a control station (a computer), a mechanical
robot, a wireless network (at the home facility—the hospital),
and a high-speed Internet connection at both the home
(hospital) and remote locations. The robot itself houses a
rechargeable power supply. Its hardware and software allows
communication over the Internet with the remote station,
interpretation of commands from the remote station and conversion
of the commands into mechanical and non-mechanical