A Randomized Comparison of Hemostasis Using New Flexible Endoscopic Bipolar Forceps (BELA) Versus Laparoscopic Bipolar Forceps in a Porcine Model

Complications During Natural Orifice Translumenal Endoscopic Surgery: Endoscopic Management of Splenic Laceration and Hemorrhage

“…Time to stop bleeding for the transgastric route was 4-72 seconds and 16-41 seconds for the transvaginal route. Thermal therapy for vascular bleeding during NOTES has also been reported in abstract form only by Park et al 12 They compared a novel flexible endoscopic forceps to a standard laparoscopic cautery forceps. Both devices performed equally well in controlling bleeding from the uterine artery, ovarian pedicle, main (or branch) inferior mesenteric artery, or pairs of mesenteric bundles.…”

Notes

“…It will be very interesting to see whether the first in vivo feasibility study using the DDES or any other similar device will be presented during next year's DDW. Park et al have nicely demonstrated the efficacy of a new proto− type of a flexible endoscopic bipolar forceps for hemostasis [58]. Again, this demonstrates the innovative boost arising from re− search in NOTES to develop new devices that can be highly valu− able for any kind of endoscopic procedure.…”

Beyond NOTES: randomized controlled study of different methods of flexible endoscopic hemostasis of artificially induced hemorrhage, via NOTES access to the peritoneal cavity

“…The combination of clip application with injection therapy or heater probe seems more successful, but results are also variable [2 ± 7] and seem unreliable for he− mostasis when the bleeding vessel is larger than 2.0 mm in diameter [8,9]. The need for of precise clip placement at the bleeding spot, which is of− ten hidden by blood, the lack of reliable and in− stantaneous closure of the vessel in certain cir− cumstances [10], and the reported re−bleeding rate make clip application a less desirable option and have already resulted in new prototype tool developments and testing for this indication [11,12]. Avoidance of re−bleeding is most important in NOTES, as the bleeding site cannot easily be re− visited once the transluminal access has been closed.…”

“…For advanced therapeutic endoscopy and especially for the new NOTES techniques it seems timely to address the unsolved prob− lem of adequate and reliable treatment of bleeding and to evalu− ate possible alternative options. This issue has also been tackled by other groups, who have tested a novel bipolar forceps and chemical substances for this purpose [11,12]. In our randomized study we compared, using transgastric and transvaginal NOTES access points, three different new prototype hemostatic devices: endoscopic suturing, monopolar forceps, and FAPC.…”