New flexible endoscopic full-thickness suturing device: a triple-arm-bar suturing system

Area of Science:

• Gastroenterology
• Surgical Innovation
• Endoscopic Surgery

Background:

• Natural orifice transluminal endoscopic surgery (NOTES) requires reliable full-thickness suturing devices.
• Existing suturing methods may have limitations in strength or ease of use.
• Assessing novel suturing technologies is crucial for advancing minimally invasive procedures.

Purpose of the Study:

• To evaluate the reliability and strength of a new triple-arm-bar suturing system (TBSS).
• To compare the performance of TBSS against established suturing methods like over-the-scope clips (OTSC) and hand-sewn sutures.
• To determine the suitability of TBSS for full-thickness suturing in endoscopic procedures.

Main Methods:

• Sixty 5-cm incisions in swine stomach tissue were sutured using OTSC, hand-sewn, or TBSS single stitches.
• Sixty endoscopic full-thickness resections (EFTRs) in swine stomachs were closed with multiple stitches (OTSC, hand-sewn, or TBSS).
• Maximum pulling force durability (MPD) was tested for all sutures; suturing time was recorded for single stitches.

Main Results:

• In single-stitch tests, TBSS and hand-sewn sutures showed no significant difference in MPD, but both were stronger than OTSC.
• In multiple-stitch tests, TBSS and hand-sewn sutures also showed no significant difference in MPD, with both outperforming OTSC.
• Suturing times varied significantly between OTSC, hand-sewn, and TBSS single-stitch applications.

Conclusions:

• The triple-arm-bar suturing system (TBSS) offers comparable strength to hand-sewn sutures for both single and multiple stitch applications.
• TBSS is a reliable suturing device suitable for full-thickness closure in endoscopic surgery.
• The findings support the potential of TBSS as a valuable tool in natural orifice transluminal endoscopic surgery (NOTES).