P0840 - Performance Characteristics of a Novel Endoscopic Insufflator: Adapting to the Future Needs of Endoscopic Surgery

Sunday, October 22, 2023

3:30 PM – 7:00 PM PT

Location: Exhibit Hall

Has Audio

Presenting Author(s)

RT

Roberto Trasolini, MD

Brigham and Women's Hospital
Boston, MA

Award: Presidential Poster Award

Roberto Trasolini, MD¹, Thomas J.. Mathews, MD², Christopher C.. Thompson, MD, MSc, FACG³
¹Brigham and Women's Hospital, Boston, MA; ²University of Kansas Medical Center, Kansas City, MO; ³Brigham and Women's Hospital, Boston, MA

Introduction: Endoscopy has advanced due to novel techniques and tools. Precise insufflation during advanced optimizes visualization and prevents barotrauma. Smoke clearance while performing resection or ablation procedures is also critical for proper visualization and safety concerns. Additionally, insufflation affects tissue pliability during suturing and is critical to precisely control endoscope position during tissue dissection. In this laboratory study, we test the characteristics of a novel insufflator to precisely control and measure lumen pressure.

Methods: Two tests were performed. A smoke clearance test was created to test capacity to rapidly insufflate and overcome the effect of endoscope suction. A clear box was modified to allow smoke insufflation and endoscope insertion without leakage (fig 1). Wood smoke was instilled until opacification and smoke cleared with maximum endoscope suction and insufflation. Two observers were blinded and assessed time to visibility using standard vs novel insufflator and pressure sensor. At the bottom of the container, a paper with the word “CLEAR” written in progressively smaller text was placed. The time from scope insertion until visualization of each of the words was recorded. Five repetitions with the control and new insufflator were performed. Second, porcine stomach was employed to assess tissue collapse with and without the insufflator at various pressure settings. A paired T-test comparing the difference of means between visualization times was performed.

Results: On average, the first word was seen at 52.6s with the insufflator versus 88.2s without (p =.033); second at 61.6s versus 104s (p = .026); third at 88.4s versus 126.4s (p = .017), fourth seen at 127s versus 177s (p = .047).

In the stomach, the insufflator was able to keep lumen pressures stable despite max suction with no collapse as low as 3mm Hg and achieved this using flow rates up to 8L/min without causing apparent barotrauma on suction release. Comparative experiments with standard insufflator at maximum flow resulted in luminal collapse and loss of visualization between a range of 4s and 13s depending on degree of starting insufflation.

Discussion: This novel insufflator and pressure monitor demonstrated superior performance in smoke clearance and had the ability to maintain visualization at pressures as low as 3mm Hg during maximum suction in a porcine model. In endosurgery this device may help improve efficiency, control and visualization.

Figure: Legend: a = porcine stomach b = insufflated lumen of pig stomach c = smoke visualization container d = smoke apparatus

	Advanced Insufflator				Standard Insufflator
Run	First Word Seen	Second Word Seen	Third Word Seen	Fourth Word Seen	First Word Seen	Second Word Seen	Third Word Seen	Fourth Word Seen
1	33	43	48	99	43	71	100	134
2	61	74	153	191	120	150	182	310
3	89	102	131	173	125	139	178	230
4	31	34	48	74	105	110	114	133
5	49	55	62	100	48	50	58	78
Mean (seconds)	52.6	61.6	88.4	127.4	88.2	104	126.4	177
SD (seconds)	23.8	27.1	49.9	51.3	39.7	42.9	53.1	92.3

Table: Table 1 – Smoke Clearance Time (seconds) Advanced versus Standard Insufflator

Disclosures:

Roberto Trasolini: Fractyl – Consultant.

Thomas Mathews indicated no relevant financial relationships.

Christopher Thompson: Apollo Endosurgery – Consultant, Grant/Research Support. Boston Scientific – Consultant, Grant/Research Support, Speakers Bureau. Endoquest Robotics – Consultant, Grant/Research Support. Endosim – Royalties. Enterasense Ltd. – Advisory Committee/Board Member, Consultant, Intellectual Property/Patents, Founder, Owner/Ownership Interest, Royalties, Stock-privately held company. EnVision Endoscopy – Advisory Committee/Board Member, Consultant, Intellectual Property/Patents, Founder, Owner/Ownership Interest, Stock-privately held company. ERBE – Consultant, Grant/Research Support. Fractyl – Advisory Committee/Board Member, Consultant, Grant/Research Support. Fujifilm – Consultant, Grant/Research Support, Speakers Bureau. GI Dynamics – Consultant, Grant/Research Support. GI Windows – Advisory Committee/Board Member, Consultant, Intellectual Property/Patents, Founder, Owner/Ownership Interest, Stock-privately held company. Lumendi – Consultant, Grant/Research Support. Medtronic – Consultant. Olympus – Consultant, Grant/Research Support, Speakers Bureau. USGI Medical – Consultant, Grant/Research Support. Xenter – Advisory Committee/Board Member, Consultant.

Roberto Trasolini, MD¹, Thomas J.. Mathews, MD², Christopher C.. Thompson, MD, MSc, FACG³. P0840 - Performance Characteristics of a Novel Endoscopic Insufflator: Adapting to the Future Needs of Endoscopic Surgery, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.