Peroral dual scope for natural orifice transluminal endoscopic surgery (NOTES) gastrotomy closure.
Fiche publication
Date publication
juin 2009
Auteurs
Membres identifiés du Cancéropôle Est :
Pr MARESCAUX Jacques
Tous les auteurs :
Asakuma M, Perretta S, Cahill RA, Solano C, Pasupathy S, Dallemagne B, Tanigawa N, Marescaux J
Lien Pubmed
Résumé
BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.
Référence
Surg Innov. 2009 Jun;16(2):97-103