Gastrotomy creation and closure for NOTES using a gastropexy technique (with video) - 23/08/11
Reprint requests: Klaus Thaler, MD, Department of Surgery, University of Missouri, One Hospital Dr, Columbia, MO 65212.Columbia, Missouri, USA
Abstract |
Background |
Safe and efficient gastrotomy creation and closure is pivotal for natural orifice transluminal endoscopic surgery (NOTES).
Objective |
To test a method of transgastric access and closure with commercially available devices.
Design |
An animal survival study.
Setting |
University hospital.
Patients |
Fifteen pigs.
Interventions |
By using a surgical suture passer, under endoscopic guidance, 3 percutaneous stay sutures were placed, in a triangular fashion, through the gastric wall. A gastrotomy was created with a dilation balloon, which was introduced over a guidewire through the gastric wall in the center of the 3 sutures. After performing a NOTES procedure, the gastrotomy was closed by tying the sutures. Necropsies were performed after 2 to 4 weeks.
Main Outcome Measurements |
Success and time of gastrotomy creation and closure, and intraoperative and postoperative complications.
Results |
Gastrotomies were successfully created and closed in all the animals. The median time to create a gastrotomy was 19 minutes (range 11-85 minutes), and the median closure time was 1 minute (range 1-45 minutes). One pig died on postoperative day 1 because of peritonitis caused by a leaking gastrotomy site that extended beyond the stay sutures. There were no other gastrotomy-related complications. All gastrotomies were well healed at the necropsy.
Limitation |
No control group.
Conclusions |
We evaluated a simple method by using the principles of the PEG technique combined with a gastropexy, which is familiar to the majority of endoscopists. Strict attention to the gastrotomy site is needed, because one leak was from the gastrotomy site that extended beyond the stay sutures.
Le texte complet de cet article est disponible en PDF.Abbreviations : CO2, IM, NOTES
Plan
Vol 68 - N° 5
P. 948-953 - novembre 2008 Retour au numéro
Article précédent
- Comparison of transgastric access techniques for natural orifice transluminal endoscopic surgery
- Stefan von Delius, Sonja Gillen, Emmanouil Doundoulakis, Armin Schneider, Dirk Wilhelm, Adam Fiolka, Stefan Wagenpfeil, Roland M. Schmid, Hubertus Feussner, Alexander Meining
- Transanal endoscopic microsurgical platform for natural orifice surgery
- Peter M. Denk, Lee L. Swanström, Mark H. Whiteford
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