Transoral incisionless fundoplication for gastro-esophageal reflux disease: Techniques and outcomes

Figure 5 Schematic representation of the Medigus Ultrasonic Surgical Endostapler (MUSE™) procedure (Courtesy of Medigus Ltd. , Omer, Israel). A: The endostapler is inserted transorally through the overtube and gently advanced into the stomach under direct vision; B: Once in the stomach, distended by insufflation of air or CO₂, the stapler is advanced until the tip is approximately 5 cm past the EGJ and then retroflexed 180° to give adequate vision of the gastric fundus and EGJ to select the stapling location. Tissue is clamped and stapled under ultrasonic guidance; C: This step is then repeated at least twice to reconstruct a robust, tight valve. Additional stapling locations should be within 60°-180° of the valve circumference (© All rights reserved to Medigus Ltd 2008-2015). EGJ: Esophago-gastric junction.