Endoscopic transgastric procedures in anesthetized pigs: technical challenges, complications, and survival

Abstract

Peroral transgastric surgery is technically feasible and safe in a porcine model. Although all the procedures were performed successfully, the study highlights some technical difficulties and illustrates the need for major technical innovations and extensive animal studies in order to evaluate the merits of incisionless surgery.

Peroral transgastric endoscopic procedures in pigs: feasibility, survival, questionings, and pitfalls

“…In this study, like in the previous ones [1][2][3][4][5][6][7][8][9][10][11][12][13][14] we found that the peroral transgastric endoscopic abdominal surgery procedures are feasible, but that they are still technically rather difficult. Consequently, we could say that they are still at a preliminary stage.…”

“…Several working groups have demonstrated the feasibility of transgastric surgery procedures with flexible endoscopes (NOTES), performing transgastric peritoneoscopy, organ resections, gastrojejunostomy, hernia repair, and ligation of fallopian tubes [1][2][3][4][5][6][7][8][9][10][11][12][13][14]. This approach, which appeared to be technically feasible, is still in its infancy and induced a number of serious complications in some or all the animals, such as hemorrhage, lacerations, intraperitoneal contamination and infection, and septic foci within the abdomen, causing considerable morbidity and mortality in otherwise healthy animals.…”

Transvaginal cholecystectomy without laparoscopic support using prototype flexible endoscopic instruments in a porcine model

“…Recently, pure NOTES cholecystectomy has been demonstrated using one transgastric scope and another through the bladder [8]. The procedure has also been done without laparoscopic support in a transgastric manner [9,10]. This could be accomplished by clipping the cystic duct and artery together which violates a principle of obtaining the critical view during laparoscopic cholecystectomy.…”

“…Multiple animal studies have looked at doing NOTES cholecystectomy without laparoscopic assistance [2][3][4][5][6][7][8][9][10]. These NOTES procedures are difficult because instruments have not been designed for this purpose and commercially available instruments are generally ineffective.…”

Chirurgische Perspektiven in der NOTES-Entwicklung

“…Tierexperimentell wurden bisher der Zugang über den Magen, das Rektosigmoid, die Vagina und die Harnblase beschrieben [3,6,7]. Dabei erprobte Operationstechniken sind die Peritoneoskopie, die Cholezystektomie, die Appendektomie, die Tubenligatur, die Oophorektomie, die Hysterektomie, die Nephrektomie, die Pankreaslinksresektion, Hernienreparationen sowie die Gastrojejunostomie [8][9][10]. Im Jahr 2007 erfolgten die ersten Operationen am Menschen, die bisher überwiegend transvaginal und in Hybridtechnik durchgeführt wurden -zum Teil auch ausschließlich mit einem Laparoskopie-Instrumentarium.…”