Novel prototype sewing device, EndoSew ® , for minimally invasive surgery: an extracorporeal ileal conduit construction pilot study in 10 patients

What's known on the subject? and What does the study add? The EndoSew® prototype was first tested in a porcine model several years ago. The investigators found it both simple to master and reliable, its greatest advantage being a 2.4-fold time saving compared with straight laparoscopic suturing. In addition to that publication, there is a single case report describing the performance of an open EndoSew® suture to close parts (16 cm) of an ileal neobladder. The time for suturing the 16 cm ileum was 25 min, which is in line with our experience. The knowledge on this subject is limited to these two publications. We report on the first consecutive series of ileal conduits performed in humans using the novel prototype sewing device EndoSew®. The study shows that the beginning and the end of the suture process represent the critical procedural steps. It also shows that, overall, the prototype sewing machine has the potential to facilitate the intracorporeal suturing required in reconstructive urology for construction of urinary diversions. Objective To evaluate the feasibility and safety of the novel prototype sewing device EndoSew® in placing an extracorporeal resorbable running suture for ileal conduits. Patients and Methods We conducted a prospective single-centre pilot study of 10 consecutive patients undergoing ileal conduit, in whom the proximal end of the ileal conduit was closed extracorporeally using an EndoSew® running suture. The primary endpoint was the safety of the device and the feasibility of the sewing procedure which was defined as a complete watertight running suture line accomplished by EndoSew® only. Watertightness was assessed using methylene blue intraoperatively and by loopography on postoperative days 7 and 14. Secondary endpoints were the time requirements and complications ≤30 days after surgery. Results A complete EndoSew® running suture was feasible in nine patients; the suture had to be abandoned in one patient because of mechanical failure. In three patients, two additional single freehand stitches were needed to anchor the thread and to seal tiny leaks. Consequently, all suture lines in 6/10 patients were watertight with EndoSew® suturing alone and in 10/10 patients after additional freehand stitches. The median (range) sewing time was 5.5 (3–10) min and the median (range) suture length was 4.5 (2–5.5) cm. There were no suture-related complications. Conclusions The EndoSew® procedure is both feasible and safe. After additional freehand stitches in four patients all sutures were watertight. With further technical refinements, EndoSew® has the potential to facilitate the intracorporeal construction of urinary diversions.

Reevaluation of the MASTER-2009 MLI and H-10 Debris Modeling

The current paper is an excerpt from the doctoral thesis ”Multi-Layer Insulation as Contribution to Orbital Debris”written at the Institute of Aerospace Systems of the Technische Universit ̈at of Braunschweig. The Multi-Layer In-sulation (MLI) population included in ESA’s MASTER-2009 (M eteoroid and Space-Debris Terrestrial Environment Reference) software is based on models for two mechanisms: One model simulates the release of MLI debris during fragmentation events while another estimates the continuo us release of larger MLI pieces due to aging related deterioration of the material. The aim of the thesis was to revise the MLI models from the base up followed by a re-validation of the simulated MLI debris population. The validation is based on comparison to measurement data of the GEO and GTO debris environment obtained by the Astronomical Institute of the University of Bern (AIUB) using ESA’s Space Debris Telescope (ESASDT), the 1-m Zeiss telescope located at the Optical Ground Station (OGS) at the Teide Observatory at Tenerife, Spain. The re-validation led to the conclusion that MLI may cover a much smaller portion of the observed objects than previously published. Further investigation of the resulting discrepancy revealed that the contribution of altogether nine known Ariane H-10 upper stage explosion events which occurred between 1984 and 2002 has very likely been underestimated in past simulations.