Self-approximating transluminal access technique for natural orifice transluminal endoscopic surgery: a porcine survival study (with video) - 23/08/11
Reprint requests: Eric M. Pauli, MD, Department of Surgery, PO Box 850 MC H149, Penn State College of Medicine, Hershey, PA 17033.Hershey, Pennsylvania, USA
Abstract |
Background |
The ability to access the abdominal cavity though a direct (modified-PEG type) gastric incision to perform natural orifice transluminal endoscopic surgery (NOTES) has been demonstrated in the literature. However, the optimal technique to access the abdomen remains unknown.
Objective |
The aim of this study was to evaluate the safety and feasibility of a transgastric approach to the abdominal cavity through an extended submucosal tunnel.
Design |
Animal feasibility study.
Interventions |
Transgastric endoscopic peritoneoscopy was performed in 7 anesthetized swine, including 2 acute and 5 survival animals. After the creation of a 10-cm to 12-cm tunnel in the gastric submucosal plane, the peritoneal cavity was accessed by needle-knife puncture through the gastric wall near the greater curvature. The peritoneal cavity was examined before the gastric mucosal incision was closed with endoclips. Survival animals were euthanized two weeks after the procedure, and a necropsy was performed.
Results |
The abdominal cavity was successfully entered without complication in all 7 animals. The mucosal incisions were able to be closed by endoscopy. In the survival experiments, all animals recovered and gained weight. Two animals experienced clinically unapparent infectious complications.
Limitations |
Small sample size.
Conclusions |
A peroral transgastric approach to the abdominal cavity through an extended submucosal tunnel is technically feasible and allows safe abdominal access and reliable closure with currently available technology. It has potential benefits as an alternative to direct transgastric access for NOTES procedures.
Le texte complet de cet article est disponible en PDF.Abbreviations : IM, NOTES, NSS, O2, STAT
Plan
Vol 67 - N° 4
P. 690-697 - avril 2008 Retour au numéro
Article précédent
- An adequate level of training for technical competence in screening and diagnostic colonoscopy: a prospective multicenter evaluation of the learning curve
- Suck-Ho Lee, Il-Kwun Chung, Sun-Joo Kim, Jin-Oh Kim, Bong-Min Ko, Young Hwangbo, Won Ho Kim, Dong Hun Park, Sang Kil Lee, Cheol Hee Park, Il-Hyun Baek, Dong Il Park, Seun-Ja Park, Jeong-Seon Ji, Byung-Ik Jang, Yoon-Tae Jeen, Jeong Eun Shin, Jeong-Sik Byeon, Chang-Soo Eun, Dong Soo Han
- CME Activity: Continuing Medical Education Exam: April 2008
- Todd H. Baron, Brenna C. Bounds, Robert Sedlack, Allan P. Weston, G.S. Raju, George Triadafilopoulos
Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.
Déjà abonné à cette revue ?