1. Endoluminal Closure Device Braham Dhillon Ali Hales Laura Mattaliano John Sticklen

2. Abdominal Surgery  Most surgeries in the peritoneal cavity currently require incision through the abdomen  New development: Natural Orifice Transluminal Endoscopic Surgery (NOTES)  NOTES – Using an endoscope, create a hole in the stomach wall (gastrotomy) to gain access to peritoneal cavity to perform surgery

3. Our Project  Problem: Currently there is no way to reliably seal the gastrotomy.  Objective: Develop a device to close a gastrotomy after a NOTES procedure – stitch, clamp, staple or otherwise seal  Benefits: incisionless surgeries, quicker recovery time (??)

4. Advisers  Mike Holzman, M.D., M.P.H. Gastrointestinal surgery, laparoscopic procedures  Gus Attwell, M.D. general gastroenterology  Alan Herline, M.D. colo rectal surgery

5. The Stomach  An external system  Digestion of food  A lot of acid and pepsin  1 st layer: thick layer of mucus  2 nd layer: antacid bicarbonate  3 rd layer: tight cell surface and folds  Perforation: hole in stomach  Severe pain, shock & hardening of wall  Bleeding into digestive tract Reference: http://www.yourdictionary.com/images/ahd/jpg/A4stomac.jpg

6. Gastroscope  A long, thin, flexible fiber optic tube with light and a camera attached  Used to examine the lining of the upper GI tract  Diagnosis and treatment of -bleeding-cancers -hiatal hernia -removal of swallowed objects -abnormalities  Biopsy taken with miniature foreceps or thin wire-loop snare Reference: http://www.gihealth.com/html/test/gastroscopy.html

7. Laparoscope  A slender tubular endoscope  Used to look at a patients abdomen or pelvis (appendix, liver, gallbladder, fallopian tubes, ovaries etc)  Small incision though which probes and other instruments are introduced.  Smaller incisions, faster recovery time, cost effective, less risky. Reference: http://www.nlm.nih.gov/medlineplus/ency/imagepages/1109.htm

8. Current Accomplishments  Meetings with Dr. Holzman  Parameters of Incision  2 cm length, Stomach wall thickness 3-5 mm  Heal within 7-14 days  Current and Potential methods  Videos  Endoscopic Surgery  Potential Solutions  Observation of Hernia Surgery  Examination of Equipment  Preliminary Research

9. Current Plan  December 6 th – Meet with Dr. Attwell  Endoscope  With CAD drawings  Requested in December  GI Mentor  Dr. Caroline Cao  Virtual reality program, simulates gastrointestinal system  Currently discussing appointment times

10. Future Plans  Explore the feasibility of using materials with “shape memory” - Nitinol - Thermoplastic polymers  Determine methods of testing procedure - Materials with properties of stomach - Testing on animal stomachs

11. Nitinol  Equal mixture of nickel and titanium  Shape of material dependent on temperature  Coil  Push through

12. Thermoplastic Polymer  Has been shown to tie itself into a knot  Absorbed by the body  Engineered to retain memory of specific shape  Transforms into that shape when heated to body temperature  Polymers that respond to UV light

13. Questions