Video Tip: Troubleshooting Bent Needle with Endoscopic Suturing | June 2024-Video Tip: Troubleshooting Bent Needle with Endoscopic Suturing

Video Transcription

This ASG video tip is sponsored by Braintree, maker of the newly approved Soufflave and Soutab.  All right, so first case, so this is an ESD TOR procedure, which is a procedure we do for weight regain after gastric bypass.  So here you're trying to load the needle onto the needle driver. You open the handle, and this happens. What is wrong here?  Does someone want to shout out, like, what is wrong with this picture? Exactly. So the needle is bent.  So this happens when you try to load the needle, i.e. close the handle, but the needle still lies outside the alignment tube.  If you do that, the needle driver might hit the needle and then bend it. So to prevent this situation, you want to make sure that when you close the handle,  you want to always pull the pickup back so that you do not see the needle outside the alignment tube. All right, what about solutions? Number one, do not take a bite, right?  Because right now the needle is bent, it's not going to meet with a needle pickup. And there are multiple ways that you can get yourself out of this.  Number one, you can pull out the pickup from the right channel, and then you pass down a rat tooth forceps, and then use the rat tooth to either remove the needle or try to  align it back to the needle driver. Alternatively, you can try to manipulate and try to put the needle back onto the pickup.  And last resort, you can also close the needle driver so that the sharp part of the needle is covered inside the alignment tube, and then you pull the whole system out.  Very important. You do not want to just pull the whole system out because the sharp part of the needle will scratch the esophagus on the way out.  So here for this situation, we were able to manipulate the needle driver, go back and forth, and then try to straighten the needle and then put it back onto the needle pickup.  So now it's back on the right side.  All right, so teaching point number one, when you try to load the needle, make sure you pull the pickup back so that the needle lies inside the alignment tube.  And then I highlight the picture here. Look at the right. Make sure you do not see the tip of the needle.

Video Summary

The video sponsored by Braintree discusses the ESD TOR procedure for weight regain after gastric bypass. The demonstration highlights the importance of loading the needle onto the needle driver correctly to prevent bending. Solutions include not taking a bite, manipulating the needle with rat tooth forceps, or closing the needle driver with the needle inside the alignment tube. It's crucial to avoid scratching the esophagus when removing the needle. The teaching point emphasizes pulling the pickup back to keep the needle inside the alignment tube and ensuring the needle is not visible at the tip during loading. This helps prevent needle bending and procedural complications.

Keywords

ESD TOR procedure

weight regain

gastric bypass

needle driver

procedural complications