Transgastric organ resection solely with the prototype R-scope and the self-approximating transluminal access technique

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8 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)170-176
Number of pages7
JournalGastrointestinal Endoscopy
Volume72
Issue number1
DOIs
StatePublished - Jul 1 2010

Fingerprint

Natural Orifice Endoscopic Surgery
Endoscopes
Cystic Duct
Equipment and Supplies
Lethargy
Cholecystectomy
Gallbladder
Surgical Instruments
Needles
Biomedical Research
Swine
Arteries
Observation
Weights and Measures

All Science Journal Classification (ASJC) codes

  • Gastroenterology
  • Radiology Nuclear Medicine and imaging
  • Medicine(all)

Cite this

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title = "Transgastric organ resection solely with the prototype R-scope and the self-approximating transluminal access technique",
abstract = "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.",
author = "Matthew Moyer and Randy Haluck and Jegan Gopal and Eric Pauli and Abraham Mathew",
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T1 - Transgastric organ resection solely with the prototype R-scope and the self-approximating transluminal access technique

AU - Moyer, Matthew

AU - Haluck, Randy

AU - Gopal, Jegan

AU - Pauli, Eric

AU - Mathew, Abraham

PY - 2010/7/1

Y1 - 2010/7/1

N2 - 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.

AB - 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.

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