Peroral Dual Scope for Natural Orifice Transluminal Endoscopic Surgery (NOTES) Gastrotomy Closure
ABSTRACT Although transgastric intraperitoneal surgery is feasible both in experimental models and humans, secure gastrotomy closure remains challenging. As there is still no method that is simple, reliable, inexpensive, and effective, we aimed to evaluate the feasibility, efficacy, and safety of a novel endoscopic approach to this issue that intends to ensure secure healing by obtaining full thickness gastric wall apposition without requiring specialized instrumentation.
Six pigs underwent general anesthesia followed by peritoneoscopy through a 12-mm gastrotomy by a double-channel endoscope. Gastrotomy closure was performed by our innovative technique. In short, this involves the insertion of a second single-channel gastroscope alongside the NOTES gastroscope. Both scopes are then worked in tandem within the stomach by separate operators using conventional endoscopic graspers and an endoclip device. The first animal was used to ascertain feasibility and standardize the technical steps, whereas the other five were survived. Postoperative follow-up then included endoscopy 1 week later and repeat endoscopy, laparoscopy, and necropsy on day 14.
All closures were immediately successful. Postoperatively, each animal demonstrated appropriate weight gain and behavioral pattern without overt postoperative complication. Necropsy showed normal healing at the gastrotomy site although there were signs of minor peritoneal irritation and infection in 2 pigs.
This transoral dual-scope clipping method of gastrotomy closure after NOTES, as well as the general concept of employing 2 separate instruments at the same time perorally, is proven technically feasible, safe, and effective in this model.
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ABSTRACT: Since the advent of Natural Orifice Translumenal Endoscopic Surgery (NOTES) and single incision laparoscopic surgery (SILS), a variety of multitasking platforms have been under development with the objective to allow for bimanual surgical tasks to be performed. These instruments show large differences in construction, enabled degrees of freedom (DOF), and control aspects.Surgical Endoscopy 09/2014; DOI:10.1007/s00464-014-3816-z · 3.31 Impact Factor
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ABSTRACT: Animal models are key elements of surgical research and promotion of new techniques. Inanimate models, anatomical specimens, and living animals are all necessary to solve the various problems encountered by the advent of a new surgical technique. The development of Natural Orifice Transluminal Endoscopic Surgery (NOTES) procedures is a representative model. Over 400 experimental procedures were performed in inanimate models, ex vivo tissues and animals to solve all problems faced by the development of NOTES surgery: peritoneal access, gastrotomy closure, exposure, retraction, dissection as well as education to start this new procedure. The successive use of all models allows to identify the ideal solution for each problem and to precisely define the safest and most reliable option to apply the new technique in patients. It allowed to perform the first transvaginal and transgastric cholecystectomy in patients in a safe way. Animal experimentation remains necessary as even sophisticated computer-based solutions are unable to model all interactions between molecules, cells, tissues, organisms, and their environment. Animal research is required in many areas to validate new technologies, develop training, let alone its major goal (namely to avoid using patients for experimentation) which is to be the first "model" for the surgeon.Langenbeck s Archives of Surgery 09/2013; 398(7). DOI:10.1007/s00423-013-1115-0 · 2.16 Impact Factor