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

Abstract

Injuries to adjacent viscera occur more often than is reported with the traditional transgastric needle knife NOTES access technique. Gastric punctures should be made either with laparoscopic visualization or by other techniques such as the PEG approach or with noncutting devices to reduce the incidence of visceral injury associated with transgastric peritoneal entry.

Pure natural orifice transluminal endoscopic surgery (NOTES) with ultrasonography-guided transgastric access and over-the-scope-clip closure: a porcine feasibility and survival study

“…Findings have shown that performing blind TG NOTES access can result in catastrophic complications [31]. One study reported a complication rate of 15.5% for gastrotomy creation with a needleknife and balloon dilation, concluding that gastric punctures should be made with laparoscopic visualization or with a percutaneous endoscopic gastrotomy (PEG)-like approach using noncutting devices [35]. The use of EUS [31,32] and the application of hydroperitoneum [36] have been evaluated in terms of reducing the risk of access-related complications.…”

Development of a feasible transrectal natural orifice transluminal endoscopic surgery (NOTES®) approach in a cadaveric appendectomy model: anterior is better

“…Palpation of the anterior abdominal wall is not exact, and proves to be ineffective if the access site is low in the pelvis. In addition, needleknife cautery followed by guidewire placement or balloon dilation may be prone to accidental injury of adjacent organs, as demonstrated in transrectal and transgastric NOTES studies [23,24].…”

Endoscopic Closure of a Tracheal Access Site Using BioGlue after Transtracheal Thoracoscopy in a Nonsurvival Canine Model

“…We previously reported that the transtracheal approaches have the advantage of enabling the surgeon to approach the target lesion head-on without the need for retroflexion, which is needed in the transesophageal approach using a gastroscope [16,17,18,19,20]. In the present study, we explored the thoracic cavity using both low and high tracheal incision methods.…”

“…One concern with the NOTES approach to the peritoneal or thoracic cavity is the risk of injuring a vital organ during wound creation [16,20]. To minimize the risk of mediastinal and lung injury, we marked the custom-designed metallic knife and tube before use, and ensured that the puncture entry of this knife did not exceed a predetermined safe length (approx.…”