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Related Experiment Video

Updated: Jun 10, 2026

Laparoscopic Cholecystectomy with Indocyanine Green Fluorescence: Choledochoscopic Stone Extraction and Primary Duct Suture

Laparoscopic Cholecystectomy with Indocyanine Green Fluorescence: Choledochoscopic Stone Extraction and Primary Duct Suture

Published on: November 25, 2025

Transvaginal cholecystectomy by using a prototype flexible clip applier.

Susan H Whang¹, Shean Satgunam, Brent W Miedema

¹Department of General Surgery, University of Missouri, Columbia, Missouri 65212, USA.

Gastrointestinal Endoscopy

|August 3, 2010

Summary

A prototype flexible endoscopic clip applier proved safe and feasible for cystic duct ligation in a porcine model during natural orifice transluminal endoscopic surgery (NOTES) hybrid cholecystectomy. Further design improvements are in progress.

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Area of Science:

Minimally Invasive Surgery
Gastroenterology
Surgical Instrumentation

Background:

Current endoscopic clips lack proven efficacy for cystic duct ligation in natural orifice transluminal endoscopic surgery (NOTES) hybrid cholecystectomy.
Development of novel instrumentation is crucial for advancing NOTES procedures.

Purpose of the Study:

To evaluate the safety and feasibility of a prototype flexible endoscopic clip applier for cystic duct ligation.
This device is unique for its flexible design and zero-gap clip deployment.

Main Methods:

A pilot study was conducted using a survival porcine model.
Transvaginal cholecystectomy was performed on 6 pigs, with cystic duct ligation using the prototype clip applier.
Safety and functionality were assessed via investigator questionnaires and 2-week necropsy.

Related Experiment Videos

Last Updated: Jun 10, 2026

Laparoscopic Cholecystectomy with Indocyanine Green Fluorescence: Choledochoscopic Stone Extraction and Primary Duct Suture

Laparoscopic Cholecystectomy with Indocyanine Green Fluorescence: Choledochoscopic Stone Extraction and Primary Duct Suture

Published on: November 25, 2025

Main Results:

Successful cystic duct clipping was achieved in all 6 pigs, with a mean clipping time of 9 minutes.
No bile leakage, infection, or injury to surrounding structures were observed at necropsy.
Challenges included clip deployment, loading, and visualization, with multiple attempts needed in 2 pigs.

Conclusions:

The prototype flexible clip applier demonstrated adequate safety and feasibility for cystic duct ligation in a preclinical setting.
Design modifications are ongoing to enhance clip visualization, loading, and release mechanisms.
This study supports continued development of flexible endoscopic tools for NOTES procedures.