Pre-clinical study on a telemetric gastric sensor for recognition of acute upper gastrointestinal bleeding: the "HemoPill monitor".

Background: Acute upper gastrointestinal bleeding is a life-threatening medical condition with a relevant risk of re-bleeding even after initial endoscopic hemostasis. The implantable HemoPill monitor contains a novel telemetric sensor to optically detect blood in the stomach allowing the surveillance of high-risk patients for re-bleedings.

Methods: In this pre-clinical porcine study, bleeding has been simulated by injecting porcine blood into the stomach of a pig through an implanted catheter using a syringe pump.

A randomized comparative trial of OTSC and Padlock for upper GI hemostasis in a standardized experimental setting.

Introduction: Upper gastrointestinal bleeding (UGIB) is the key emergency situation in clinical endoscopy and is traditionally treated with injection, thermal or through the scope clipping therapy. Mortality rates are in the range of 8-10% and demand new treatment approaches. The Over-The-Scope Clip (OTSC) has been described as a very effective hemostatic device in UGIB.

TST36 stapling for rectocele and hemorrhoidal prolapse - early results of the prospective German multicenter study.

The aim of the study was to evaluate the safety and feasibility of stapled transanal procedures performed by a 36 mm stapling device, the so-called TST36 stapler. From September 2013 to June 2014 a prospective observational study was carried out by 8 proctology centers in Germany. The Cleveland Clinic Incontinence Score (CCIS) for incontinence and the Altomare ODS score were determined preoperatively.

Telemetric real-time sensor for the detection of acute upper gastrointestinal bleeding.

Acute upper gastrointestinal bleedings from ulcers or esophago-gastric varices are life threatening medical conditions which require immediate endoscopic therapy. Despite successful endoscopic hemostasis, there is a significant risk of rebleeding often requiring close surveillance of these patients in the intensive care unit (ICU). Any time delay to recognize bleeding may lead to a high blood loss and increases the risk of death.

Design and Performance of a Low-Cost Telemetric Laparoscopic Tactile Grasper.

Tactile feedback is completely lost in laparoscopic surgery, which would provide information about tissue compliance, texture, structural features, and foreign bodies. We developed a system with artificial tactile feedback for laparoscopic surgery that consists of a telemetric tactile laparoscopic grasper, a remote PC with customized software, and a commercial video-mixer. A standard, nonsensorized laparoscopic grasper was customized to allow the integration of a tactile sensor and its electronics.

Porcine survival model to simulate acute upper gastrointestinal bleedings.

The existing animal models used for the simulation of acute gastrointestinal bleedings are usually non-survival models. We developed and evaluated a new porcine model (domestic pig, German Landrace) in which the animal remains alive and survives the artificial bleeding without any cardiovascular impairment. This consists of a bleeding catheter which is implanted into the stomach, then subcutaneously tunnelled from the abdomen to the neck where it is exteriorized and fixed with sutures.

Endoscopic full-thickness resection and clip defect closure in the colon with the new FTRD system: experimental study.

Background: The benefit of endoscopic full-thickness resection is the improved diagnostic work-up with an integral wall specimen which allows a precise determination of the tumor or its precursor and its infiltration depth into the wall.

Materials And Methods: A new endoscopic full-thickness resection device (FTRD), which is a combination of a modified over-the-scope-clip (OTSC) system with an electrocautery snare, has been tested in an experimental setting. In eleven pigs, divided into three groups, endoscopic full-thickness resection was performed in the colon at one or two sites, respectively.

The OTSC® Proctology clip system for anal fistula closure: first prospective clinical data.

Introduction: Anorectal fistulas represent a troublesome condition for both patient and surgeon. The OTSC® Proctology clip system is a new device for transanal anorectal fistula closure.

Material And Methods: The OTSC® Proctology system was evaluated in a prospective clinical study undertaken in two surgical proctological centers.

The OTSC® Proctology clip system for anorectal fistula closure: the 'anal fistula claw': case report.

Abstract Surgical treatment of high or complex anal fistulas often renders unsatisfying results. This is the report of the first successful closure of such anal fistula using a special Nitinol clip and applicator, the OTSC® Proctology system (Ovesco AG, Tuebingen, Germany): A 54-year old female patient was suffering from a high transsphincteric anal fistula. After seton drainage of the fistula for ten weeks, the fistula track was debrided using a special fistula brush.

The OTSC®-clip in revisional endoscopy against weight gain after bariatric gastric bypass surgery.

The maintenance of the restrictive component of the Fobi pouch gastric bypass is essential for permanent weight control. Dilatation of the pouch-outlet and of the pouch itself is responsible for substantial weight gain by an increased volume per meal and binge-eating due to the rapid emptying. An endoscopic over-the-scope clip (OTSC®; Ovesco AG, Tübingen, Germany) was applied in 94 patients following gastric bypass and unintended weight gain by dilated gastro-jejunostomy to narrow the pouch-outlet.

Fluorescence-guided minimally invasive parathyroidectomy: clinical experience with a novel intraoperative detection technique for parathyroid glands.

Background: Detection of normal and pathologic parathyroid glands often is difficult due to their variability in number and location. We have implemented photosensitizer-induced fluorescence for the routine intraoperative identification of parathyroids for the surgical treatment of hyperparathyroidism.

Methods: From 2004 to 2007, 25 patients suffering from primary and secondary hyperparathyroidism underwent minimally invasive videoscopic-assisted parathyroidectomy after oral photosensitization with aminolevulinic acid (ALA).

A new serrated snare for improved tissue capture during endoscopic snare resection.

Endoscopic snare resection of gastrointestinal polyps and neoplasm is a standard procedure in interventional endoscopy. Due to technical and procedural improvements the removal of large sessile polyps can be achieved by endoscopic mucosal resection either in one single specimen or by piecemeal resection. In this experimental study a new snare with special teeth attached to the distal part of the wire loop was evaluated and compared to a conventional snare.

Fluorescence-guided minimally invasive parathyroidectomy: a novel surgical therapy for secondary hyperparathyroidism.

Secondary hyperparathyroidism (SHPT) is a severe and frequent complication in patients with advanced chronic kidney disease, characterized by hyperplasia of all parathyroid glands and elevated serum parathyroid hormone levels. When surgery is required to prevent cardiovascular consequences, bone pain, osteoporosis, or even soft-tissue calcifications, detection of the enlarged glands often can be difficult because of their variability in number and location. A novel surgical technique, fluorescence-guided minimally invasive parathyroidectomy, may facilitate intraoperative localization of parathyroid glands.

Evaluation of MR-angiography for pre-operative assessment of living kidney donors.

Introduction: Pre-operative magnetic resonance tomography (MR) and MR-angiography (MRA) have rendered favorable results for the assessment of renal anatomy preceding living-related kidney transplantation. However, limited value of MRA in the detection of accessory renal vasculature is reported.

Methods: We compared the results of pre-operative contrast-medium-enhanced MRA of the last 30 consecutively performed nephrectomies in living kidney donors with the intraoperative findings of vascular, parenchymal, and ureteral anatomy.

Enhanced ALA-induced fluorescence in hyperparathyroidism.

Introduction: Intraoperative localization of parathyroid glands can be challenging especially in minimally invasive surgery. Fluorescence diagnosis using the photosensitizer aminolevulinic acid (ALA) has been described to identify normal parathyroid glands during experimental bilateral neck exploration. The present study evaluated fluorescence differences between hyperplastic and normal parathyroid glands as a precondition for a clinical application of the technique.

Mycotic aneurysm of the abdominal aorta with retroperitoneal abscess: successful endovascular repair.

Mycotic aortic aneurysms are rare. Improved diagnostic procedures, appropriate antibiotic treatment, and safe surgical techniques have reduced the high mortality associated with bacterial aortitis. However, definite evidence-based conclusions with regard to the surgical strategy cannot be drawn from the data available in the published literature.

Kinetics of intraoperative fluorescence diagnosis of parathyroid glands.

Objective: Identification of parathyroid glands is often a challenge even for experienced surgeons. The feasibility and efficacy of fluorescence diagnosis for localization of parathyroids has already been proven in an experimental setting. In preparation for a clinical application of this technique in patients undergoing surgery for hyperparathyroidism, we evaluated the kinetics of fluorescence diagnosis.

Vascular occlusion by ruptured balloon after percutaneous transluminal angioplasty.

Purpose: To report a rare case of chronic vascular occlusion by an undetected ruptured balloon fragment following percutaneous transluminal angioplasty.

Case Report: A 79-year-old man suffered from calf claudication 1 year after angioplasty for a short stenosis in the superficial femoral artery. During the femoropopliteal bypass operation, a ruptured angioplasty balloon was retrieved.

Laparoscopic fluorescence diagnosis for intraabdominal fluorescence targeting of peritoneal carcinosis experimental studies.

Objective: To assess 5-aminolevulinic acid (ALA)-induced protoporphyrin IX accumulation and fluorescence in peritoneal colon carcinoma metastases and its benefits for laparoscopic fluorescence diagnosis.

Summary Background Data: Occult, macroscopically nonvisible peritoneal micrometastases can be missed in laparoscopy or open surgery. Laparoscopic fluorescence diagnosis allows detection of these lesions after intraperitoneal lavage with ALA and subsequent fluorescence induction by blue-light excitation.