Natural-orifice transgastric endoscopic peritoneoscopy in humans: Initial clinical trial

Hazey, Jeffrey W.; Narula, Vimal K.; Renton, David; Reavis, Kevin M.; Paul, Christopher M.; Hinshaw, Kristen E.; Muscarella, Peter; Ellison, E. Christopher; Melvin, W. Scott

doi:10.1007/s00464-007-9548-6

Cited by 208 publications

(135 citation statements)

References 8 publications

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“…Patients seem to be early adopters of the technology, perhaps owing to a perception that surgical risk is related to incision size, whereas surgeons prefer to wait for more safety and efficacy outcome data. 32 Years after NOSCAR published the white paper on NOTES in 2005, and although various NOTES procedures have now been tested in humans, 25,26,[33][34][35][36] investigators continue to rely on animal models to better understand and overcome several of the barriers precluding NOTES from wide clinical adoption. In brief, we have shown the feasibility of transcolonic NOTES peritonoscopy and abscess drainage in a canine survival study.…”

Section: Resultsmentioning

confidence: 99%

“…2,11,[23][24][25][26] Our study introduces an "abscess" into the abdominal cavity to assess transcolonic peritonoscopy in this setting. Specifically, we wanted to examine our ability to adequately visualize important predetermined areas: the peritoneal reflection in the pelvis, sigmoid colon, appendix, midjejunum, right lobe of the liver, right subphrenic space, lesser curvature of the stomach and left hepatic space.…”

Section: Discussionmentioning

confidence: 99%

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NOTES for the management of an intra-abdominal abscess: transcolonic peritonoscopy and abscess drainage in a canine model

Moustarah

Talarico²,

Zinc³

et al. 2013

Can J Surg

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Background:We studied natural orifice transcolonic drainage of intra-abdominal abscesses in a canine survival model to evaluate the difficulty of peritonoscopy and abscess drainage and the reliability of endoluminal colotomy closure. Methods:We placed a 7 cm nonsterile saline-filled latex balloon intra-abdominally to mimic or induce an abscess or inflammatory mass. Seven days later, we advanced a single-channel endoscope transanally into the sigmoid colon of the animal, made a colotomy and then advanced the endoscope intraperitoneally. We evacuated the identified abscess and placed a drain transabdominally. We closed the colotomy endoluminally with a tissue approximation system using 2 polypropylene sutures attached to metal T-bars. Two weeks later, we evaluated the colotomy closure at laparotomy. Results:We studied 12 dogs: 8 had subphrenic balloon implants and 4 had interbowel loop implants. Eleven survived and underwent transcolonic peritonoscopy; we identified the "abscess" in 9. The colotomy was successfully closed in 10 of 11 dogs. Although abscesses were easily identified, the overall difficulty of the peritonoscopy was moderate to severe. One dog required colotomy closure via laparotomy, while 9 had successful endoluminal closure. After colotomy closure, 8 animals survived for 2 weeks (study end point) without surgical complications, sepsis or localized abdominal infections. On postmortem examination, all closures were intact without any adjacent organ damage or procedure-related complications. Conclusion:Natural orifice transluminal endoscopic surgery provides a novel alternative to treating intra-abdominal pathology. It is technically feasible to perform endoscopic transcolonic peritonoscopy and drainage of an intra-abdominal abscess with reliable closure of the colotomy in a canine experimental model. Contexte :Nous avons étudié le drainage transcolique par voie naturelle d'abcès intraabdominaux dans un modèle canin de survie afin d'évaluer la difficulté de la péritono-scopie et du drainage des abcès, ainsi que la fiabilité de la fermeture endoluminale de la colotomie.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

NOTES for the management of an intra-abdominal abscess: transcolonic peritonoscopy and abscess drainage in a canine model

Moustarah

Talarico²,

Zinc³

et al. 2013

Can J Surg

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“…Se identificaron un total de 184 estudios que reportaban los resultados de los procedimientos quirúrgicos (intrabdominales) mediante NOTES incluyendo cuatro realizados en humanos en el 2007 [18][19][20][21][22][23][24][25][26][27] . Sólo uno fue comparativo, este estudio con un nivel de evidencia III-2, coteja la peritoneoscopia mediante NOTES con la laparoscopia diagnóstica en 10 pacientes con masas pancreáticas para estadificación mediante laparoscopia.…”

Section: Resultsunclassified

Cirugía endoscópica trans orificios naturales (NOTES)

O¹,

Useche

2009

Rev Chil Cir

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Systematic review of natural orifice transluminal endoscopy surgery (NOTES) for intrabdominal surgeryBackground: NOTES allows to perform entire traditional surgical procedures through a natural orifice. Aim: To evaluate models, techniques, outcomes, pitfalls, and applicability to the clinical setting of NOTES for intra abdominal surgery. Material and Methods: Systematic review of the literature. Studies were identified searching MEDLINE, EMBASE, CINAHL, Current Contents, Cochrane Library, Entrez PubMed, Clinical Trials Database from 2000 to 2008. Studies indentified in October 2008, were included if they were performed in live human subjects. Results: Of the studies included for review, most were experimental studies conducted in animals. Thus, the evidence base was very limited. Although intra-abdominal access could be achieved reliably via oral, anal, or urethral orifices, the optimal access route and method could not be established. Closure of viscerotomies could not be achieved reliably in all cases and the risk of peritoneal infection was not adequately evaluated. Although the majority of interventions could be performed in animals using NOTES, a number of technical problems were encountered that need to be resolved. Conclusions: NOTES is still in early stages of development and more robust technologies will be needed to achieve reliable closure and overcome technical challenges. Well-managed human studies need to be conducted to determine the safety and efficacy of NOTES in a clinical setting.

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“…However, transgastric peritoneoscopy being developed by Kalloo et al [7,19] showed no association with serious infection or other complications in the peritoneal cavity during their longterm survival experiments. Furthermore, Hazey et al [20] reported that although contamination in the abdomen was documented, no clinically significant episode of the peritoneal cavity was observed without abscess formation or infectious complications during laparoscopic Roux-en-Y gastric bypass. From those findings, although the peroral TGLB required to add the artificial injury for normal organs, it will become one of alternatives to another LB methods.…”

Section: Discussionmentioning

confidence: 99%

“…This report was similar to our procedure and results. In clinical, Hazey et al [20] reported that LB was uneventfully performed from the transgastric access route in a patient who underwent a diagnostic laparoscopic evaluation of pancreatic mass. Steele et al [24] also reported that LB from segments II, III, or IVb under flexible transgastric peritoneoscopy during Roux-en-Y gastric bypass for morbid obesity was www.intechopen.com performed in 3 patients with only minor bleeding from the liver biopsy sites.…”

Section: Discussionmentioning

confidence: 99%