Transmitted Light Tissue Thickness Analysis (TiLTT)
Transmitted Light Tissue Thickness Analysis (TiLTT)
To assess gastric wall thickness using transmitted light intensity.
The most common surgical procedure for weight loss is the sleeve gastrectomy. The
 laparoscopic sleeve gastrectomy (LSG) involves the linear stapling of the stomach using a
 stapling device [e.g. Echelon (Ethicon Somerset NJ)] fired multiple times along the length of
 the stomach thereby excising 80-90% of the stomach leaving the patient with a "sleeve" of
 stomach rather than the normal anatomical pouch. The gastric wall varies in thickness and
 thus there are a varied staple sizes available for this use. Staple sizes range from
 2.0mm-5.0mm in height. In standard surgical practice the surgeon chooses the size of staple
 cartridge for each subsequent firing based on his experience and estimations about the
 thickness of the stomach tissue in any given region. The drawback of this technique is that
 it is highly inaccurate. If the surgeon's estimation is in error, the staple height chosen
 may be either too tall or too short leading to bleeding or leakage from between the staples
 or malformed/unformed staples leading to staple line failure. Any of these errors can lead to
 devastating complications such as hemorrhage, leak, sepsis and death. To date there is no
 objective way to measure the thickness of the tissue being stapled and thus staple choice
 relies entirely on surgeon estimation which is inherently inaccurate. The investigators
 hypothesize that a light source placed in the stomach lumen will transmit light through the
 gastric wall. The amount of light transmitted, i.e. visible to an imaging device arrayed
 external to the stomach, will be directly proportionate to the thickness of the stomach. This
 study will take advantage of the fact that during routine procedures in the sleeve
 gastrectomy procedure a lighted tube is placed into the gastric lumen via the mouth. This
 device is called the Gastrisail and has 10 separate LED lights arrayed along its length. This
 allows for the measurement of transmitted light intensity through the gastric wall at 10
 individual locations along the length f the stomach. In addition this study will take
 advantage of the fact that during standard practice in a sleeve gastrectomy a section of the
 stomach corresponding to the location of the lights is excised and sent for pathological
 evaluation. This will allow us to measure the actual thickness of the stomach at 10 points
 corresponding to he locations of the transmitted light intensity. For this measurement The
 investigators will use a standardized and validated measurement tool/calipers. Now with two
 sets of numbers the investigators plan to correlate the degree of transmitted light intensity
 with actual thickness measurements and thereby reach an algorithm which will allow the
 transmitted light intensity data alone to predict gastric wall thickness. This will provide
 the surgeon with an entirely non-invasive objective measure of gastric wall thickness and
 hopefully improve his/her choice of staple size during these surgical procedures thus
 improving safety.
Inclusion Criteria:

 -  Subject has provided informed consent

 -  Subject is between the ages of 18 and 80 years of age

 -  Subject is scheduled for and undergoes primary sleeve gastrectomy

 Exclusion Criteria:

 -  Revisional Bariatric Surgery