Sleeve gastrectomy, which is based on reducing the size of the stomach, is one of the most successful bariatric surgeries and is yet to be standardized. One of the reasons is the lack of a method to obtain an accurate remnant stomach volume. The weight loss obtained postsurgery is highly correlated with the remnant stomach volume. Therefore, it is important to get consistently an accurate remnant stomach volume to be able to compare sleeve gastrectomy with other surgeries and in order to predict the weight loss. In addition, the measurement of the pyloric pressure is important for understanding the mechanism of weight loss and predicting complication postsurgery. A surgical assistive device for sleeve gastrectomy surgery is presented in this paper. The purpose of this instrument is to assist surgeons in obtaining an accurate remnant stomach volume and in measuring the pyloric pressure. The device consists of several inflatable compartments controllable by the surgeon. Prototype laboratory test results gave an accuracy of 96.7% and a repeatability of 97.6% for different desired volumes using air for compartment inflation, and an accuracy of 96.3% and a repeatability of 98.4% for different desired volumes using water for compartment inflation. The pressure measurement accuracies obtained are 96.8% using air and 99.7% using water. It is worth noting that these accuracies are expected to differ when the device is tested in vivo.
Issue Section:
Design Innovation
Keywords:
biological organs,
biomedical equipment,
biomedical measurement,
diseases,
pressure measurement,
surgery,
medical device,
bariatric surgery,
obesity,
stomach volume,
stomach pressure
Topics:
Instrumentation,
Pressure,
Surgery,
Design,
Testing,
Pressure measurement,
Water,
Cylinders,
Fluids,
Weight (Mass)
1.
Santry
, H. P.
, Gillen
, D. L.
, and Lauderdale
, D. S.
, 2005, “Trends in Bariatric Surgical Procedures
,” JAMA, J. Am. Med. Assoc.
0098-7484, 294
(15
), pp. 1909
–1917
.2.
2000, “
The Practical Guide: Identification, Evaluation, and Treatment of Overweight and Obesity in Adults
,” North American Association for the Study of Obesity (NAASO) and the National Heart, Lung, and Blood Institute (NHLBI), NIH Publication No. 00-4084.3.
Bult
, M. J. F.
, van Dalen
, T.
, and Muller
, A. F.
, 2008, “Surgical Treatment of Obesity
,” Eur. J. Endocrinol.
0804-4643, 158
(2
), pp. 135
–145
.4.
Kueper
, M. A.
, Kramer
, K. M.
, Kirschnia
, A.
, Königsrainer
, A.
, Pointner
, R.
, and Granderath
, F. A.
, 2008, “Laparoscopic Sleeve Gastrectomy: Standardized Technique of a Potential Stand-Alone Bariatric Procedure in Morbidly Obese Patients
,” World J. Surg.
0364-2313, 32
(7
), pp. 1462
–1465
.5.
Quesada
, B. M.
, Roff
, H. E.
, Kohan
, G.
, Oría
, A. S.
, and Luis
, T. C. P.
, 2008, “Laparoscopic Sleeve Gastrectomy as an Alternative to Gastric Bypass in Patients With Multiple Intra Abdominal Adhesions
,” Obes. Surg.
0960-8923, 18
(5
), pp. 566
–568
.6.
Butte
, J. M.
, Devaud
, N.
, Jarufe
, N. P.
, Boza
, C.
, Pérez
, G.
, Torres
, J.
, Pérez-Ayuso
, R. M.
, Arrese
, M.
, and Martínez
, J.
, 2007, “Sleeve Gastrectomy as Treatment for Severe Obesity After Orthotopic Liver Transplantation
,” Obes. Surg.
0960-8923, 17
(11
), pp. 1517
–1519
.7.
Clinical Issues Committee of the American Society for Metabolic and Bariatric Surgery
, 2007, “Sleeve Gastrectomy as a Bariatric Procedure
,” Surg. Obes. Relat. Dis.
, 3
(6
), pp. 573
–576
.8.
Deitel
, M.
, Crosby
, R. D.
, and Gagner
, M.
, 2007, “The First International Consensus Summit for Sleeve Gastrectomy (SG)
,” Obes. Surg.
0960-8923, 18
, pp. 487
–496
.9.
Weiner
, R.
, Weiner
, S.
, Pomhoff
, I.
, Jacobi
, C.
, Makarewicz
, W.
, and Weigand
, G.
, 2007, “Laparoscopic Sleeve Gastrectomy—Influence of Sleeve Size and Resected Gastric Volume
,” Obes. Surg.
0960-8923, 17
(10
), pp. 1297
–1305
.10.
Braghetto
, I.
, 2007, “Laparoscopic Sleeve Gastrectomy: Surgical Technique, Indications and Clinical Results
,” Obes. Surg.
0960-8923, 17
(11
), pp. 1442
–1450
.11.
Yehoshua
, R. T.
, and Eidelman
, L. A.
, 2008, “Lapogastric Sleeve Gastrectomy—Volume and Pressure Assessment
,” Obes. Surg.
0960-8923, 18
(9
), pp. 1083
–1088
.12.
Schulze-Delrieu
, K.
and Herman
, R. J.
, 1998, “Changes in the Position and Angulation of Incisura During Contractions of the Isolated Cat Stomach
,” Neurogastroenterol Motil
1350-1925, 10
(4
), pp. 281
–288
.13.
Scheurer
, U.
, Varga
, L.
, Drack
, E.
, Bürki
, H. R.
, and Halter
, F.
, 1983, “Measurement of Cholecystokinin Octapeptide-Induced Motility of Rat Antrum, Pylorus, and Duodenum In Vitro
,” Am. J. Physiol.
0002-9513, 244
(3
), pp. G261
–G265
.14.
Nakarna
, A.
, Hirota
, S.
, Okazaki
, T.
, Nagano
, K.
, Kawano
, S.
, Hori
, M.
, and Kitamura
, Y.
, 1998, “Disturbed Pyloric Motility in Ws/Ws Mutant Rats Due to Deficiency of c-Kit-Expressing Interstitial Cells of Cajal
,” Pathol. Int.
1320-5463, 48
(11
), pp. 843
–849
.15.
Zhao
, X.
, Yin
, J.
, Chen
, J.
, Song
, G.
, Wang
, L.
, Zhu
, H.
, Brining
, D.
, and Chen
, J. D.
, 2008, “Inhibitory Effects and Mechanisms of Intestinal Electrical Stimulation on Gastric Tone, Antral Contractions, Pyloric Tone and Gastric Emptying in Dogs
,” Am. J. Physiol. Regulatory Integrative Comp. Physiol.
0363-6119, 296
, pp. R36
–R42
.16.
Heddle
, R.
, Dent
, J.
, Toouli
, J.
, and Read
, N. W.
, 1988, “Topography and Measurement of Pyloric Pressure Waves and Tone in Humans
,” Am. J. Physiol. Gastrointest. Liver Physiol.
, 255
(4
), pp. 490
–G497
.17.
Thorn
, M.
, Kremer
, M.
, Heimann
, T.
, Schmied
, B. M.
, Schemmer
, P.
, Richter
, G. M.
, Z’graggen
, K.
, Büchler
, M. W.
, and Meinzer
, H. -P.
, 2004, “Accurate Volume Measurement for Liver Surgery In Vivo Evaluation With a Pig Model
,” Computer Assisted Radiology and Surgery (CARS 2004) 18th International Congress and Exhibition
, Chicago, IL, Jun. 23–26.18.
Khalaf
, H.
, Shoukri
, M.
, Al-Kadhi
, Y.
, Neimatallah
, M.
, and Al-Sebayel
, M.
, 2007, “Accurate Method for Preoperative Estimation of the Right Graft Volume in Adult-to-Adult Living Donor Liver Transplantation
,” Transplant. Proc.
0041-1345, 39
(5
), pp. 1491
–1495
.19.
Kothapalli
, B.
, and Durdle
, N. G.
, 1989, “Multichannel Data Acquisition System for Gastric Motility
,” IEEE Symposium on Computer-Based Medical Systems
, pp.130
–134
, Jun. 26–27.20.
Rabbani
, K. S.
, Hassan
, M.
, Kabir
, A. B. M. H.
, Ahmed
, M.
, and Nahar
, S.
, 1995, “Electrical Impedance Tomography (EIT) in the Frontal Plane Using Ring Electrode Configuration
,” Engineering in Medicine and Biology Society, 1995 and 14th Conference of the Biomedical Engineering Society of India
, Feb. 15–18, pp. 1/43
–1/44
.21.
Tomek
, J.
, Mlejnek
, P.
, Janásek
, V.
, Ripka
, P.
, Kašpar
, P.
, and Chen
, J.
, 2008, “The Precision of Gastric Motility and Volume Sensing by Implanted Magnetic Sensors
,” Sens. Actuators, A
0924-4247, 142
(1
), pp. 34
–39
.22.
Soulsby
, C. T.
, Khela
, M.
, Yazaki
, E.
, Evans
, D. F.
, Hennessy
, E.
, and Powell-Tuck
, J.
, 2006, “Measurements of Gastric Emptying During Continuous Nasogastric Infusion of Liquid Feed: Electric Impedance Tomography Versus Gamma Scintigraphy
,” Clin. Nutr.
0261-5614, 25
(4
), pp. 671
–680
.23.
Zangen
, S.
, Di Lorenzo
, C.
, Zangen
, T.
, Mertz
, H.
, Schwankovsky
, L.
, and Hyman
, P. E.
, 2001, “Rapid Maturation of Gastric Relaxation in Newborn Infants
,” Pediatr. Res.
0031-3998, 50
(5
), pp. 629
–632
.24.
Wang
, G. -J.
, Tomasi
, D.
, Backus
, W.
, Wang
, R.
, Telang
, F.
, Geliebter
, A.
, Korner
, J.
, Bauman
, A.
, Fowler
, J. S.
, Thanos
, P. K.
, and Volkow
, N. D.
, 2008, “Gastric Distention Activates Satiety Circuitry in the Human Brain
,” Neuroimage
1053-8119, 39
(4
), pp. 1824
–1831
.25.
Roewer
, N.
, “Stomach Tube
,” U.S. Patent No. 5,462,528.26.
Hurwitz
, A.
, 1981, “Measuring Gastric Volume by Dye Dilution
,” Gut
0017-5749, 22
(2
), pp. 85
–93
.27.
Taylor
, W. J.
, Champion
, M. C.
, Barry
, A. W.
, and Hurtig
, J. B.
, 1989, “Measuring Gastric Contents During General Anaesthesia: Evaluation of Blind Gastric Aspiration
,” Can. J. Anaesth.
0832-610X, 36
, pp. 51
–54
.28.
Nagar
, M.
, 2008, “Human Anatomical Models
,” http://www.esscoindia.com/site/anatomicalmodels.htmlhttp://www.esscoindia.com/site/anatomicalmodels.html29.
Styblinski
, M. A.
, 1990, “Design for Circuit Quality: Yield Maximization, Minimax, and Taguchi Approach
,” Proceedings of the IEEE ICCAD’90
, Santa Clara, CA, Nov., pp. 112
–115
.30.
Fraley
, S.
, Oom
, M.
, Terrien
, B.
, and Zalewsk
, J.
, “Design of Experiments via the Taguchi Method: Applying Orthogonal Arrays
,” http://controls.engin.umich.edu/wiki/index.php/Design_of_experiments_via_taguchi_methods:_orthogonal_arrayshttp://controls.engin.umich.edu/wiki/index.php/Design_of_experiments_via_taguchi_methods:_orthogonal_arrays31.
Bhutta
, K.
, 2003, “Taguchi Approach to Design of Experiments
,” Proceedings of the SW DSI
.32.
Akingbehin
, K.
, 2005, “Taguchi-Based Metrics for Software Quality
,” Proceedings of the Fourth Annual ACIS International Conference on Computer and Information Science
, Jul. 14–16, IEEE Computer Society
, Washington, DC
, pp. 713
–716
.Copyright © 2010
by American Society of Mechanical Engineers
You do not currently have access to this content.
