Comparison of transgastric access techniques for natural orifice transluminal endoscopic surgery

Reducing the unexpectedly high rate of injuries caused by NOTES gastrotomy creation

“…These include the intended intra-abdominal procedure, the ease of gastrotomy creation, and the ease of closure. Each of these factors can affect the occurrence of complications [9,10,12]. If one intends to perform a gastrotomy on the anterior wall of the middle of the stomach, this site can usually be identified by transillumination of the abdominal wall, as is done when placing a PEG tube with the endoscope light.…”

“…Several studies have described various transgastric access techniques such as incision with a needle knife, balloon dilatation after needle knife puncture, incision using sphincterotome after puncture, creation of a submucosal tunnel within the gastric wall, and a PEG-like approach [1,[9][10][11][12]. Balloon dilatation after needle knife puncture is widely used due to the simplicity, ease, and swiftness of the approach.…”

Natural orifice translumenal endoscopic surgery: critical appraisal of applications in clinical practice

“…A multitude of endoscopic methods have been evaluated [32][33][34][35], with good initial results from the use of porcine in vivo and ex vivo models. It is imperative that clinicians maintain strong relations with the industry in developing and conducting scientifically robust trials before human studies begin, to determine the optimum access and closure methods.…”

Natural orifice transluminal endoscopic surgery (NOTES) in animals

“…access techniques (Delius et al 2008) compared several techniques for transgastric peritoneal access: a 1.5 to 2 cm longitudinal incision, balloon dilation after needle knife puncture, via a short submucosal tunnel and via an elongated submucosal tunnel. A needle knife is used to perform a longitudinal incision in the abdominal wall.…”