CUTTING THREAD AT FLEXIBLE ENDOSCOPY

Background: New thread-cutting techniques were developed for use at fl exible endoscopy. A guillotine was designed to follow and cut thread a t the endoscope tip. A new method was developed for guiding suture cut ters. Efficacy of Nd:YAG laser cutting of threads was studied. Experim ental and clinical experience with thread-cutting methods is presented . Methods: A 2.4 mm diameter flexible thread-cutting guillotine was co nstructed featuring two lateral holes with sharp edges through which s utures to be cut are passed. Standard suture cutters were guided by ba ckloading thread through the cutters extracorporeally. A snare cutter was constructed to retrieve objects sewn to tissue. Efficacy and speed of Nd:YAG laser in cutting twelve different threads were studied. Res ults-The guillotine cut thread faster (p < 0.05) than standard suture cutters. Blackloading thread shortened time taken to cut thread (p < 0 .001) compared with free-hand cutting. Nd:YAG laser was ineffective in cutting uncolored threads and slower than mechanical cutters. Results of thread cutting in clinical studies using sewing machine (n = 77 cu tting episodes in 21 patients), in-vivo experiments (n = 156), and pos tsurgical cases (n = 15 over 15 years) are presented. Conclusions: New thread-cutting methods are described and their efficacy demonstrated in experimental and clinical studies.