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Technical Brief

Endoscopic closure of large defects with a novel clipping device and a 4S-Modified Roeder slipknot

[+] Author and Article Information
Shuchen Ge

School of Medical Instrument and Food Engineering, University of Shanghai for Science and Technology, Shanghai, China, 200093; Earl. E. Bakken Medical Devices Center, University of Minnesota, MN, 55455
shawngesc@gmail.com

Liaoyuan Ai

School of Medical Instrument and Food Engineering, University of Shanghai for Science and Technology, Shanghai, China, 200093
ailiaoyuan1990@163.com

Arthur Erdman

Earl. E. Bakken Medical Devices Center, University of Minnesota, MN, 55455
agerdman@umn.edu

Chengli Song

School of Medical Instrument and Food Engineering, University of Shanghai for Science and Technology, Shanghai, China, 200093
csong@usst.edu.cn

1Corresponding author.

ASME doi:10.1115/1.4039753 History: Received October 30, 2017; Revised January 25, 2018

Abstract

Endoscopic closure is an essential procedure in gastrointestinal (GI) surgery, but currently it is difficult to close large defects endoscopically because of lacking appropriate device. Previously we developed a novel endoscopic clipping device, which has multi-firing function and is equipped with an independent clamp. The goal of this study is to provide a new closure method with this device and 4S-Modified Roeder (4SMR) slipknot. The mechanical strengths of the slipknot as regards to tensioning forces is also evaluated. The feasibility of the closure method is examined by deploying two clips during one insertion onto the 4SMR slipknot to close a 5 cm full-thickness linear defect of an ex-vivo porcine stomach from the center. The mechanical strength of the 4SMR slipknot is verified by mean peak forces to failure, while the knot is tensioning by 2.5, 5, 7.5 and 10 Newton force (n=20 for each group) respectively. Experimental results indicate tensioning force has a great influence on the mechanical strength of slipknot, with the mean peak force (tensioning force) being 7.1± 6.5, 16.3±9.3, 18.9±10.4 and 24.2±12.0 Newtons respectively. In conclusion, the proposed closure method can be used for large defects. Tensioning force higher than five Newtons is suitable to ensure a stronger 4SMR slipknot.

Copyright (c) 2018 by ASME
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