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ROBOTIC ENDOLUMINAL SLEEVE GASTROPLASTY (R-ESG): TECHNICAL FEASIBILITY OF A NOVEL PROCEDURE IN AN EX-VIVO PORCINE STOMACH
Nicha Srisuworanan
*2, Pichamol Jirapinyo
1, Christopher C. Thompson
11Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, MA; 2Mahidol University Faculty of Medicine Siriraj Hospital, Bangkok, Bangkok, Thailand
Background: Endoscopic sleeve gastroplasty (ESG) is an endoscopic treatment for patients with obesity. The procedure involves suturing the greater curvature side of the stomach, leading to gastric volume reduction, early satiety and weight loss. Though ESG has shown favorable weight loss outcomes, the procedure is technically demanding and limited by the lack of dexterity seen with conventional endoscopic suturing devices. Therefore, the endoluminal robotic system was developed to overcome these challenges. The enhanced dexterity of the articulated instruments and the flexibility of the robotic system allow the operators to perform difficult maneuvers including suturing at various angles. In this study, we aim to demonstrate the technical feasibility of the novel Robotic Endoluminal Sleeve Gastroplasty (R-ESG) using the Endoluminal Operating System (EOS) in ex-vivo porcine stomach model.
Method: R-ESG was performed in 20 porcine stomachs. The first row of suture was performed with a continuous linear suture from posterior, greater curvature, to anterior wall at the level of incisura angularis, to create a "distal belt" of the sleeve. The 2
nd, 3
rd, 4
th and 5
th rows of sutures were made in a continuous w-pattern to plicate the greater curvature side of the stomach leaving the narrow lumen on the lesser curvature. The sutures continued toward the esophagogastric junction. Then, the reinforcing suture was placed over the plication sutures in continuous "zigzag" pattern from the distal to proximal stomach to help reduce tension on each plication suture.
Results: The procedures were successfully performed in all porcine stomachs (100% technical feasibility) without adverse event or perforation (0% adverse event rate). Full-thickness suture placement was consistently achieved. The gastric lumen was reduced to less than half of its initial size.
Conclusion: Robotic ESG is technically feasible in the ex vivo model. The endoluminal robotic platform with improved visualization and enhanced movement, may potentially improve clinical outcomes and allow more physicians to adopt this procedural technique.
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