title: Initial experience with a novel endoscopic device allowing intragastric manipulation and plication.
abstract: BACKGROUND
  Current developments in intraluminal and transluminal natural orifice surgery are limited by issues of access, tissue manipulation, and secure tissue approximation/closure. This report describes an initial laboratory experience with a novel tissue approximation and suturing device. The device is deployed via a previously described platform and is 6 mm in diameter. Desirable qualities of this tissue approximation/closure device include robust tissue grasping, minimal tissue trauma, fully visualized anchor placement via off-axis needle and anchor deployment, full reloadability without instrument withdrawal, single-operator operating capability, torque-stable manipulability, and operator-controlled tension setting of tissue anchor pairs.
  
  
  METHODS
  The device was trialed in performing several maneuvers in porcine or canine models. The features of the system allowed bimanual tissue manipulation, full-thickness tissue approximation and plication, and secure closure of an ex vivo gastrotomy hole similar to that used during transluminal surgical interventions.
  
  
  CONCLUSIONS
  This device appears to offer promise in achieving more complex endoluminal and potentially transluminal tasks, including secure suture closure of tissue defects and access holes. As such, devices of this type may prove useful in addressing some of the identified barriers to further development of natural orifice surgical intervention. Further investigation of the qualities and capabilities of this device in these settings is warranted.
authors: Department of Surgery, Medical College of Georgia, Augusta, GA, USA. jmellinger@mcg.edu
authors: John D
authors: JD
authors: Mellinger
authors: Bruce V
authors: BV
authors: MacFadyen
authors: Richard A
authors: RA
authors: Kozarek
authors: Nathaniel D
authors: ND
authors: Soper
authors: Desmond H
authors: DH
authors: Birkett
authors: Lee L
authors: LL
authors: Swanstrom
mesh_terms: D000818:Animals; D004285:Dogs; D020699:Gastroscopes; D005773:Gastroscopy; D023421:Models, Animal; D013270:Stomach / Q000601:surgery*; D013536:Suture Techniques / Q000295:instrumentation*; D013552:Swine