and Solutions for Surgery, Laparoscopy and Endoscopy:
AttachLifter and AttachGuider
based on "dual control of vacuum attachment"
The devices provide a novel tool for tissue grabbing, manipulation
and serve as fixation point in flexible endoscopy
Tissue is traditionally grasped
with forceps
or a rigid suction head (upper left corner). To reduce
suction
pressure required for tissue attachment, we developed devices
with
flexible sealing clamps (lower left corner). Less suction pressure
relates
to less tissue injury while the tissue remains more firmly and securely
attached. An
electronic device is available for monitoring secure
tissue attachment. When the device is turned, e.g. by
90°, the tissue is lifted, i.e. AttachLifter. This approach is used
for accessing the normal pericardial sac, where the pericardium is very
close to the underlying epicardium and where there is a high risk of
puncturing the epicardium with the inherent risk of fatal pericardial
tamponade, i.e. the risk inherent in the conventional needle technique.
The devices can be used stand-alone or in a working channel of an endoscope. The applications are manifold.
Pericardial access for pericardiocentesis, epicardial ablation or intrapericardial therapy
Currently, the example of pericardial access is described in detail. The pericardium is lifted away from the epicardium using a suction head with flexible clamps followed by insertion of a needle into the pericardial cavitiy. Without the flexible clamps, turning of the suction head can be associated with loss of vacuum due to the irregular tissue structure of the pericardium with subsequent failure of accessing the pericardial cavitiy.
Removal of pericardial effusion and intrapericardial drug therapy
Epicardial lead implantation for cardiac resynchronization therapy (CRT)
Fixation point for flexible endoscopy
The flexible clamps provide also a long sought tool for providing a fixation point required in all endoscopy work. The fixation point providing a stable operating environment is one of the advantages of rigid endoscopy but is absent in conventional flexible endoscopy. The stable operating environment is particularly important for intra-luminal surgery where surgery is performed with an endoscope inserted through a natural body orifice (NOTES). This aspect has been pointed out e.g. in "Stabilizing instrumentation for the performing of endoscopic surgical procedures". Some stabilization can be provided by pushing the side of the endoscope against the body conduit or gastrointestinal wall, but this technique does not adequately allow a surgeon to manipulate the tissue of an internal body lumen to perform precise surgical procedures. A fixation point is essential for intra-luminal surgery using an endoscope because, without it, the risks of inadvertent perforation, uncontrolled bleeding, and unacceptable surgical margins are high. A fixation point can be provided by the suction head(s) with flexible clamps. For example, biopsy of the stomach wall or other manipulation as part of a NOTES procedure can be performed after fixation of the device (e.g. AttachGuider) with flexible clamps. In the most simple approach, the device has a "working channel" with a conventional flexible endoscope with small diameter which after fixation is used for the tissue manipulation. Without a suction head with flexible clamps, the conventional endoscope could not be properly positioned. It appears that the suction head with flexible clamps according to Rupp et al. provides a major breakthrough in flexible endoscopic surgery.
Gastrointestinal diseases
A possible application is also in Transanal Endoscopic Microsurgery (TEM) which is a minimally invasive technique for the local resection of rectal tumours. TEM was developed in 1983 by Professor Dr. Gerhard Buess in Tuebingen, Germany and is used now worldwide, e.g. in over 100 US sites. For details on the procedure, see Burghardt J and Buess G, Floyd ND and Saclarides TJ or Dana R Sands.
While in TEM the size of the suction head is not critical, a smaller size is required for a regular endoscope when the suction head is within the working channel or remains outside and is used "in tandem" with the endoscope (as described in principle for our AttachGuider). Irrespective of the design, the suction head could also be used for biopsy or resection of flat polyps or adenomas (Endoscopic Mucosal Resection, EMR). Very flat polyps can be impossible to snare and even after submucosal saline injection cannot be snared. Currently, there are at least two approaches available: a snare which can dig into the mucosa such as the barbed snare or the "cap with suction" technique. Using a cap with suction (see e.g. Fig. 25 of ERBE), flat polyps can be grasped, lifted and snared.
The advantage of the AttachLifter device over conventional vacuum grabbers is the greater grasping force despite a lower suction pressure. The flexible clamps have a sealing function, thereby preventing loss of vacuum when uneven tissue is attached to the head. The tissue grabbing is not lost when the suction head is slightly tilted since the captured tissue is kept within the suction head also by mechanical forces, i.e. tissue is "behind" the sealing clamps and cannot easily "escape" from behind the sealing clamps.
Upcoming applications for the AttachLifter in gynecology
Myomectomy (hysteroscopic or laparoscopic removal of uterine fibroids)
Transurethral resection of the prostate
Our international patent applications:
TransMIT GmbH works at
the
interface between universities and businesses. TransMIT assists scientists in
protecting
their inventions and provides assistance in the marketing of
technologies
and developments. For
information
on the pending
patent of the Marburg Attacher and follow-up devices, please
contact
Dr. Peter Stumpf, Managing Director,
TransMit
or Heinz Rupp.
For information on management of pericardial disease, please contact Prof. Dr. Bernhard Maisch.
Copyright © 2008 H. Rupp
A website maintained by Cardiorepair.com
The devices can be used stand-alone or in a working channel of an endoscope. The applications are manifold.
Pericardial access for pericardiocentesis, epicardial ablation or intrapericardial therapy
Currently, the example of pericardial access is described in detail. The pericardium is lifted away from the epicardium using a suction head with flexible clamps followed by insertion of a needle into the pericardial cavitiy. Without the flexible clamps, turning of the suction head can be associated with loss of vacuum due to the irregular tissue structure of the pericardium with subsequent failure of accessing the pericardial cavitiy.
Removal of pericardial effusion and intrapericardial drug therapy
Epicardial lead implantation for cardiac resynchronization therapy (CRT)
Fixation point for flexible endoscopy
The flexible clamps provide also a long sought tool for providing a fixation point required in all endoscopy work. The fixation point providing a stable operating environment is one of the advantages of rigid endoscopy but is absent in conventional flexible endoscopy. The stable operating environment is particularly important for intra-luminal surgery where surgery is performed with an endoscope inserted through a natural body orifice (NOTES). This aspect has been pointed out e.g. in "Stabilizing instrumentation for the performing of endoscopic surgical procedures". Some stabilization can be provided by pushing the side of the endoscope against the body conduit or gastrointestinal wall, but this technique does not adequately allow a surgeon to manipulate the tissue of an internal body lumen to perform precise surgical procedures. A fixation point is essential for intra-luminal surgery using an endoscope because, without it, the risks of inadvertent perforation, uncontrolled bleeding, and unacceptable surgical margins are high. A fixation point can be provided by the suction head(s) with flexible clamps. For example, biopsy of the stomach wall or other manipulation as part of a NOTES procedure can be performed after fixation of the device (e.g. AttachGuider) with flexible clamps. In the most simple approach, the device has a "working channel" with a conventional flexible endoscope with small diameter which after fixation is used for the tissue manipulation. Without a suction head with flexible clamps, the conventional endoscope could not be properly positioned. It appears that the suction head with flexible clamps according to Rupp et al. provides a major breakthrough in flexible endoscopic surgery.
Gastrointestinal diseases
A possible application is also in Transanal Endoscopic Microsurgery (TEM) which is a minimally invasive technique for the local resection of rectal tumours. TEM was developed in 1983 by Professor Dr. Gerhard Buess in Tuebingen, Germany and is used now worldwide, e.g. in over 100 US sites. For details on the procedure, see Burghardt J and Buess G, Floyd ND and Saclarides TJ or Dana R Sands.
While in TEM the size of the suction head is not critical, a smaller size is required for a regular endoscope when the suction head is within the working channel or remains outside and is used "in tandem" with the endoscope (as described in principle for our AttachGuider). Irrespective of the design, the suction head could also be used for biopsy or resection of flat polyps or adenomas (Endoscopic Mucosal Resection, EMR). Very flat polyps can be impossible to snare and even after submucosal saline injection cannot be snared. Currently, there are at least two approaches available: a snare which can dig into the mucosa such as the barbed snare or the "cap with suction" technique. Using a cap with suction (see e.g. Fig. 25 of ERBE), flat polyps can be grasped, lifted and snared.
The advantage of the AttachLifter device over conventional vacuum grabbers is the greater grasping force despite a lower suction pressure. The flexible clamps have a sealing function, thereby preventing loss of vacuum when uneven tissue is attached to the head. The tissue grabbing is not lost when the suction head is slightly tilted since the captured tissue is kept within the suction head also by mechanical forces, i.e. tissue is "behind" the sealing clamps and cannot easily "escape" from behind the sealing clamps.
Upcoming applications for the AttachLifter in gynecology
Myomectomy (hysteroscopic or laparoscopic removal of uterine fibroids)
Transurethral resection of the prostate
Our international patent applications:
Care has been taken
to
protect the claims from possible competition from other technologies
(including inferior ones). Inlicencing enquiries are welcome. The
patent applications can be downloaded as PDFs: Attacher.pdf,
AttachLifter.pdf,
AttachGuider.pdf
The
AttachLifter
and associated devices have been developed at the Department of
Internal
Medicine and Cardiology (Director: Prof. Dr. B. Maisch) of the Heart Center and the
Technical Development Plant of the Medical Center and Medical
Faculty of the Philipps
University
of Marburg, Office
for
Research and Technology.
The team involved in the production of the Marburg Attacher and associated devices: Prof. Dr. Heinz Rupp, Prof. Dr. Bernhard Maisch, Thomas P. Rupp MD
Karin Rupp, Michael Koch, Ekkehard Schüler, Hermann Schön.
Patent application and marketing is in cooperation with TransMIT
The team involved in the production of the Marburg Attacher and associated devices: Prof. Dr. Heinz Rupp, Prof. Dr. Bernhard Maisch, Thomas P. Rupp MD
Karin Rupp, Michael Koch, Ekkehard Schüler, Hermann Schön.
Patent application and marketing is in cooperation with TransMIT
For
general
information on the AttachLifter and other devices, please contact Heinz
Rupp:
For information on the use
of
the AttachLifter in general surgery, please contact Thomas P. Rupp, MD For information on management of pericardial disease, please contact Prof. Dr. Bernhard Maisch.
Copyright © 2008 H. Rupp
A website maintained by Cardiorepair.com