BACKGROUND: The self-approximating transluminal access technique (STAT) has been demonstrated to provide safe transluminal access and in-line endoscope positioning to target abdominal organs during natural orifice transluminal endoscopic surgery (NOTES). To date, organ resection with NOTES has typically required percutaneous assistance. We hypothesized that the in-line positioning and partial stability provided by STAT would allow single-access NOTES procedures if a multiarticulated endoscope could be used. OBJECTIVE: Assessment of single-site NOTES, using STAT and a prototype, multi-articulated endoscope. DESIGN: Animal survival study. SETTING: Penn State Hershey Medical Center Research Laboratories. INTERVENTIONS: Thirteen pigs underwent NOTES using a prototype endoscope with 2 articulated channels, a grasping forceps, and an insulated-tip needle-knife. The gallbladder was dissected using a fundus down technique, and hemoclips and a detachable loop were placed on the cystic duct and artery before removal. After a 2- to 3-week observation period, animals were euthanized and necropsy performed. RESULTS: All target organs were successfully resected without laparoscopic assistance. Significant complications were 2 perforations (1 caused by a prototype duodenal occlusion device and 1 caused by enterotomy during cholecystectomy) and 1 entrapment of the small bowel with an endoloop. Postoperatively, all animals gained weight appropriately with 1 killed on postoperative day 12 because of lethargy (cystic duct leak/biloma). LIMITATIONS: This is a limited animal survival study without control arm. CONCLUSIONS: The combination of the R-scope and STAT does allow effective, single-site NOTES procedures; however, although the R-scope provides improved tissue manipulation and visibility, the complications incurred here suggest that further improvements in devices and technique will be required for safe and effective single-site NOTES procedures. Copyright 2010 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved.
BACKGROUND: The self-approximating transluminal access technique (STAT) has been demonstrated to provide safe transluminal access and in-line endoscope positioning to target abdominal organs during natural orifice transluminal endoscopic surgery (NOTES). To date, organ resection with NOTES has typically required percutaneous assistance. We hypothesized that the in-line positioning and partial stability provided by STAT would allow single-access NOTES procedures if a multiarticulated endoscope could be used. OBJECTIVE: Assessment of single-site NOTES, using STAT and a prototype, multi-articulated endoscope. DESIGN: Animal survival study. SETTING: Penn State Hershey Medical Center Research Laboratories. INTERVENTIONS: Thirteen pigs underwent NOTES using a prototype endoscope with 2 articulated channels, a grasping forceps, and an insulated-tip needle-knife. The gallbladder was dissected using a fundus down technique, and hemoclips and a detachable loop were placed on the cystic duct and artery before removal. After a 2- to 3-week observation period, animals were euthanized and necropsy performed. RESULTS: All target organs were successfully resected without laparoscopic assistance. Significant complications were 2 perforations (1 caused by a prototype duodenal occlusion device and 1 caused by enterotomy during cholecystectomy) and 1 entrapment of the small bowel with an endoloop. Postoperatively, all animals gained weight appropriately with 1 killed on postoperative day 12 because of lethargy (cystic duct leak/biloma). LIMITATIONS: This is a limited animal survival study without control arm. CONCLUSIONS: The combination of the R-scope and STAT does allow effective, single-site NOTES procedures; however, although the R-scope provides improved tissue manipulation and visibility, the complications incurred here suggest that further improvements in devices and technique will be required for safe and effective single-site NOTES procedures. Copyright 2010 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved.
Authors: Tae Jun Song; Dong Wan Seo; Su Hui Kim; Do Hyun Park; Sang Soo Lee; Sung Koo Lee; Myung-Hwan Kim Journal: Gut Liver Date: 2012-10-18 Impact factor: 4.519