All right guys, we're going to be doing, we have one question from the audience and it will be the last, or the question we answer and then we're going to move on to a quick colonic stent demonstration. And the question was, can you perform interrupted sutures with this device? Is there any reason you would prefer that as compared to continuous? In my practice, I don't. I think in our surgeons, they are often doing interrupted sutures for various incisions. But you know, this primarily is meant for, overstitch is primarily meant for a continuous suture just for what we use it for, for perforation closure. You want a continuous suture to get that nice pull together from all the walls to really close things in. You know, ESG or endoscopic sleeve gastrectomy technically uses multiple sutures in different steps. But it's one continuous suture, then another continuous suture, then another. But in general, you're going to be mostly doing continuous suturing. All right, so we're going to quickly move on to the colonic stent. So say we have, on our device we have a malignant stricture. Say we have a colon cancer. So let's go ahead. Here's our colon cancer, and it's causing an obstruction in the colon, which is right here. Sorry. That's okay. We got some, we have an open abdomen. And so normally we would have this under fluoroscopy to guide us, but because we can see into the, we've made a transection of the person's body, we can see, we don't need a fluoroscopic guidance. So what we're going to first do is we're looking on the scope view. If we look, we've met our point of the stricture, and we're going to thread a guide wire. I generally recommend, if you can, a long wire. These require therapeutic endoscopes in order to be placed. You can't do this usually on a normal gastroscope, but you would need either an adult colonoscope or a therapeutic endoscope. You can't even do it on a pediatric, typically you can't do it on a pediatric colonoscope. So say now for simplicity, we're going to go ahead and thread our guide wire over. And if you look on the model over here, you can see our guide wire has come all the way through to the other end. And now, we have currently on us, for our colonic stent, we have an uncovered stent, but it is a Wallflex 22 millimeter by 90 millimeter. These come in different sizes, and you can discuss with your rep the different sizes, but generally 22 versus 90 or 22 versus 12, they have different ones. And the 90, or excuse me, 120 or 90 centimeter. So the 22 is the width of the stent, and the 90 is the length of the stent, okay, in millimeters. So here I am, and I would be threading this down my channel. And this is the benefit of a long wire because you would be able to do this, we're just going to pretend we have a long wire. Ideally, you would have a long wire, you would feed this down until we could get all the, let's see if we can feed, yeah, we're not feeding out all our wire, but you want to be able to get it on to this end, if you look right here, nope, to the end right here. And I'm just going to do this, ideally you have, so the long wire will be able to make sure you can keep this in place, all right, and it's getting closer, good, all right. So this is supposed to guide us, so go ahead and, so I want you to go ahead, if you look on the scope right here, you can see right here, this is the start of the stent, you can see that mesh wiring in between it, and as we push out, yeah, we just might get rid of this guide wire, to be honest with you, but, I want you to feed this, so you can see us feeding it across the stricture, and generally you want at least two centimeters proximal and two centimeters distal to the stricture in order to keep this in place, okay. So if we have a 90, there's the end of the stent, okay, so if we have a 90 millimeter length stent, or nine centimeters, that means we have to have it straddled at least two centimeters in front and two centimeters in back, so that's four, so we would need two, and then we have seven left, so we need at least then, it would go two, then let's say this is a two centimeter stricture, it would be four, and then we'd have five, and so you can use your markings on the colonoscope to kind of help gauge that. So there's the end of our stent, okay, so now, over here, your tech's going to do, is going to say, I'm ready to start deploying, and this would be all under fluoro, and so I want you to kind of, let's see if we can get a better view of this, there we go, there, that's what I want to see, okay, and so what the tech is going to do, is now it's going to start plunging, and we have several radio opaque markers, and what I want you to do, Dr. TJ, is just give me some back tension on this to keep it in place, as I go forward, you want to keep this in place, we want to make sure we have this in place, so pull back, so go ahead and start giving me the model for the camera, go on in, and you can start seeing the first flange going up right here, starting to deploy, okay, so that's starting to, keep giving back tension, just try to keep that in place, so I'm basically unsheathing, so there's that first, try to keep it in place, that first stent, see how it opened up, pan on over here for me, so it's opened up as I've, and if you've not, you'll have a marker that says the point of no return, basically you can't resheath that, so if I was to pull back I could resheath this before that, okay, but now I'm pushing it out, you can see I've got that flange deployed, and now I'm deploying the second one, boom, and now we've done our colonic stent, so you can see now we've traversed this stricture, we've opened up, we've allowed this patient to have a nice palliative stenting, I'm going to be honest with you, anytime you deploy one of these you should have your colorectal surgeons involved, there are serious risks for, or significant risks for perforations whenever you're stenting a malignancy, so you should be at least having oncology and colorectal surgery aware that you're placing one of these, the other thing I will say is these often are malignant obstructions that have been building up for a long time, you should be gowned up from head to toe, you're going to get a lot of spillage of stool coming out after, okay, this really concludes our session, do you have any other questions for us, if not please feel welcome to reach out to us, I want to thank you for this opportunity to meet with us, again I'm Dr. Mamadi, and I'm Dr. TJ, we're signing out, but thank you so much guys, really appreciate everything and giving us this opportunity to teach with you, you can reach out to us or the course faculty anytime, thank you, alright, see you later.

interrupted sutures

colonic stent placement

continuous sutures

malignant stricture

colorectal surgeons