Peroral Dual Scope for Natural Orifice Transluminal Endoscopic Surgery (NOTES) Gastrotomy Closure

ArticleinSurgical Innovation 16(2):97-103 · July 2009with6 Reads
DOI: 10.1177/1553350609337309 · Source: PubMed
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.
    • "Using two endoscopes to provide layer-by-layer endoscopic clip closure was another alternative that uses current endoscopic instruments [15] . An original technique using a cardiac septal occluder has demonstrated a zero leak rate [16] . The system was widely used for survival studies on animal models but it was not transferable to the clinical setting for cost issues and concerns about the long term outcome of the intraperitoneal, non absorbable part of the mechanism made with nitinol. "
    [Show abstract] [Hide abstract] ABSTRACT: After the first report by Kalloo et al on transgastric peritoneoscopy in pigs, it rapidly became apparent that there was no room for an under-evaluated concept and blind adoption of an appealing (r)evolution in minimal access surgery. Systematic experimental work became mandatory before any translation to the clinical setting. Choice and management of the access site, techniques of dissection, exposure, retraction and tissue approximation-sealing were the basics that needed to be evaluated before considering any surgical procedure or study of the relevance of natural orifice transluminal endoscopic surgery (NOTES). After several years of testing in experimental labs, the revolutionary concept of NOTES, is now progressively being experimented on in clinical settings. In this paper the authors analyse the challenges, limitations and solutions to assess how to move from the lab to clinical implementation of transgastric endoscopic cholecystectomy.
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  • [Show abstract] [Hide abstract] ABSTRACT: To give a conceptual description of natural orifice translumenal endoscopic surgery (NOTES), review the early efforts in the NOTES field, and discuss its challenges and limitations. The data were retrieved mainly from publications listed in MEDLINE, PubMed and China Wanfang Database from 2005 to 2009. The search term was "NOTES". The articles involved in the "NOTES" study were selected and the review articles were excluded from the comparison. A marked increase in quantity in articles was shown each year for NOTES studies from 2006 to 2009. Animal experiments with "NOTES" have been carried out in China from 2007, and two independent "NOTES" procedures on humans were reported in 2009. Although still in its infancy, the "NOTES" procedure is promising as another type of minimally invasive surgery and favorable alternative to current interventions.
    Article · Jan 2010
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