TITLE: SPARC Pig1 acute wired ColoMOCA implantation
AUTHORS: Dennis Bourbeau, Brett Hanzlicek, Margot Damaser

[DESCRIPTION]
<div class = "text-blocks"><div class = "text-block"> In this study, we will be using Yorkshire Pigs, 50-70kg.  The purpose of this study is to develop a tool to measure bowel fullness and activity. This system will eventually be able to provide continuous, wireless, battery−powered data and ultimately be translated for use in research and clinicalapplications of bowel function. We will measure porcine bowel compliance, pressures, and dimensions in acute live animal studies.</div></div>

[STEPS]
?. [Anesthesia Preparation]
Anesthesia Preparation    Pigs will be initially anesthetized with an intramuscular dose of telazol (4.4−6.6 mg/kg). The animals will then be intubated orotracheally and maintained on isoflurane in oxygen (1-5%; depending on anesthetic depth). Anesthetic depth will be measured by the response to stimulus, heart rate, respiratory rate and eye position.    A peripheral catheter will be placed in an auricular vein for administration of fluids. Buprenorphine may be administered IM or IV (0.02−0.1 mg/kg).
?. [Surgical Preparation]
Surgical Preparation     After anesthesia preparation, place the pig in a supine position. Insert a urine catheter with help of a guidewire and tape the catheter to side of the pig. The catheter reduces pressure that a bladder with urine would put on the colon.         We use a 10F Dover catheter (Covidien; Catalog # 8887603101)
?. [Surgical Preparation]
Calibrate air-charged anorectal manometry catheter (Laborie T-DOC) on benchtop.    This catheter consists of a large balloon for rectal pressure and small balloons to collect anal sphincter pressure.
?. [Intrarectal Testing]
Insert speculum (anoscope) approximately 10 cm into the rectum and remove stool.    Empty the  bowel of stools by manual disimpaction.
?. [Intrarectal Testing]
Insert ColoMOCA into the rectum through an anoscope using a mucosal tool (Boston Scientific Resolution Clip) with clip. Deploy clip to attach the ColoMOCA to the mucosa of the rectum.    -Place the clip around the "handle"/loop of the ColoMOCA, insert into the rectum and deploy clip.
?. [Intrarectal Testing]
Test for signal from the ColoMOCA.    -The ColoMOCA is powered using wires that run to a power supply.  The ColoMOCA collects pressure data using 2 pressure transducers.  The device also collects conductance, conductivity  and capacitance measurements using 4 electrodes that are attached to the device.  All data are wirelessly transmitted to a receiving coil (chataMOCA) outside of the body, which is connected to a laptop.  The data is visualized and collected using Labview software.
?. [Intrarectal Testing]
Press on abdomen.    -After confirming that the chataMOCA is receiving a wireless signal from the ColoMOCA, press (2-3 seconds) down on the lower abdomen where the ColoMOCA is (internally) attached.    -Confirm pressure response from ColoMOCA
?. [Intrarectal Testing]
Remove anoscope and press lower abdomen again.      -Confirm pressure response from ColoMOCA
?. [Intrarectal Testing]
Insert T-DOC Balloon catheter for reference pressure; add 10 ml water to the large balloon.    -The pressure as measured through the balloon catheter will be recorded as a function of volume infused into the balloon catheter, which will be used to calculate the bowel compliance.  The balloon pressure will also be used as reference pressure for the ColoMOCA.
?. [Intrarectal Testing]
Press on lower abdomen multiple times and record balloon and ColoMOCA pressure.    -Balloon catheter responding    -Wait around 30 seconds between presses
?. [Intrarectal Testing]
Remove balloon catheter.    -Device still in the rectum
?. [Intrarectal Testing]
Setting up conductivity testing.    -Conductivity, conducatance and capacitance testing is performed using 4 electrode on the ColoMOCA in response to the device being in contact with real and artificial stool.
?. [Intrarectal Testing]
Insert anoscope then insert real stool through the anoscope onto the ColoMOCA.
?. [Intrarectal Testing]
Press on abdomen multiple times, 2-3 seconds each.    -Record pressure and electrode data from the ColoMOCA
?. [Intrarectal Testing]
Remove real stool Press on abdomen multiple times, 2-3 seconds each.     -Record pressure and electrode data from the ColoMOCA
?. [Intrarectal Testing]
Repeat steps 15 and 16.
?. [Intrarectal Testing]
Insert Artificial Stool into the rectum, onto the ColoMOCA.
?. [Intrarectal Testing]
Press on abdomen multiple times, 2-3 seconds each     -Record pressure and electrode data from the ColoMOCA
?. [Intrarectal Testing]
Remove artificail stool.  Press on abdomen multiple times, 2-3 seconds each.     -Record pressure and electrode data from the ColoMOCA
?. [Intrarectal Testing]
Twist/rotate sensor so that the pressure sensors are facing wall of the bowel proximal to the abdomen.  Press on abdomen multiple times, 2-3 seconds each.     -Record pressure and electrode data from the ColoMOCA
?. [Intrarectal Testing]
Rotate sensor so that the pressure sensors are facing away from the pressure from the abdomen.  Press on abdomen multiple times, 2-3 seconds each.     -Record pressure and electrode data from the ColoMOCA
?. [Intrarectal Testing]
Insert balloon catheter approximately 2 cm into rectum and inflate with 10ml water.
?. [Euthanasia]
Euathanize pig with Beuthanasia (100mg/kg IV)
?. [Intrarectal Testing]
Measure stools and bowel    -Measure the size of the stools, including diameter and length.    -Measure the dimensions of the colon, rectum, and anus, including diameters and lengths.
?. [Post Mortem]
Measure colon and stool dimensions, including thickness and impedances
?. [Intrarectal Testing]
Press on abdomen multiple times, 2-3 seconds each.     -Record pressure and electrode data from the ColoMOCA  and pressure data from the balloon catheter.
?. [Intrarectal Testing]
Rotate sensor so that the pressure sensors are facing wall of the bowel proximal to the abdomen.  Press on abdomen multiple times, 2-3 seconds each.     -Record pressure and electrode data from the ColoMOCA and pressure data from the balloon catheter.
?. [Intrarectal Testing]
Remove balloon catheter and ColoMOCA.