Studies to develop a laparoscopic instrument for obtaining diagnostic quality full thickness intestinal biopsies in horses

O'Meara, Bryan J. (2014) Studies to develop a laparoscopic instrument for obtaining diagnostic quality full thickness intestinal biopsies in horses. MVM(R) thesis, University of Glasgow.

Abstract

Currently, there is no widely used minimally invasive technique in human or veterinary medicine, which allows for intracorporeal full thickness intestinal biopsy (FTIB). The aim of this study was to investigate the design of a prospective laparoscopic FTIB instrument including an exploration of techniques to excise and close the biopsy excision site (BES). This was achieved by a preliminary investigation. This involved the identification of the possible techniques; screening of the techniques based on a scoring system devised from the desired requirements of the instrument; and then a short list of the techniques were evaluated by an appropriate test. This included a histological examination to determine the optimal technique for excision and intra-luminal bursting pressures to assess the BES closure method. The optimal biopsy excision technique (BET) was then adopted as part of a prototype biopsy instrument and used to obtain 30 biopsies from the distal jejunum and ileum of three horses, which had been euthanized for reasons unrelated to gastrointestinal disease. The histological quality of the biopsy sample was assessed by a boarded histopathologist and scored 1 (Excellent) - 6 (Very Poor). The BES closure method was incorporated as part of a prototype instrument and evaluated by intra-luminal bursting pressures. The positive attributes and potential modifications of the instrument are reported. The optimal excision shape and technique was a U-shape used in a “chopping board-like” technique (CBT). The prototype instrument obtained an average biopsy score of 3.46 (Five biopsy scored very good, twelve biopsy scored good, six scored acceptable and seven scored poor). A lack of mucosa or disruption of the mucosal layer was the most common reason for down grading of samples. Myenteric ganglia and/or submucosal ganglia were present in all of the Prototype 2 biopsy samples. The U- shaped BET used as part of the CBT excision technique has the potential to be used as part of a laparoscopic instrument to obtain full thickness intestinal biopsy from the intestine and a curved double row of staples used in a manner similar to a linear stapler offer a potential closure method as part of a one step laparoscopic instrument.

• Item Type: Thesis (MVM(R))
• Qualification Level: Masters
• Keywords: Laparoscopic Instrument, full thickness intestinal biopsy, Equine
• Subjects: R Medicine > R Medicine (General); R Medicine > RD Surgery; R Medicine > RZ Other systems of medicine
• Colleges/Schools: College of Medical Veterinary and Life Sciences > School of Biodiversity, One Health & Veterinary Medicine
• Supervisor's Name: Love, Prof. Sandy and Pollock, Mr. Patrick
• Date of Award: 2014
• Depositing User: Mr Bryan J O'Meara
• Unique ID: glathesis:2014-4978
• Copyright: Copyright of this thesis is held by the author.
• Date Deposited: 12 Jun 2014 14:12
• Last Modified: 30 Jun 2014 09:04
• URI: https://theses.gla.ac.uk/id/eprint/4978