Self-approximating transluminal access technique for natural orifice transluminal endoscopic surgery: a porcine survival study (with video)

Durability of the self-approximating translumenal access technique (STAT) for potential use in natural orifice translumenal surgery (NOTES)

“…However, certain limitations of the technique also were identified. Our work to date has shown that STAT can provide reliable, peroral, transgastric peritoneal access, and more importantly, it provides a technically easy, secure means of gastrotomy closure [9,10].…”

“…Our work to date has shown that STAT provides reliable peroral transgastric access, allowing for peritonoscopy targeted to one of the four abdominal quadrants, and most importantly, provides a technically easy, secure means of gastrotomy closure [9][10][11]. In brief, STAT involves creating a submucosal pillow (by saline injection) and a mucosal incision at an appropriate entry site, advancing the endoscope into the submucosal space for instrument dissection to accomplish blunt creation of a 10-to 15-cm-long tunnel along the dissection plane, incising the seromuscular layer to complete translumenal access, and closing the tract by reapproximation of the mucosal layers with endoscopically placed clips (Fig.…”

Reliability of gastric access closure with the self-approximating transluminal access technique (STAT) for NOTES

“…STAT was performed as previously reported [12,14]. Briefly, a saline cushion was made in the proximal posterior wall of the stomach and incised using a needle knife to open the submucosal plane.…”

“…1) and involves the dissection of a submucosal tunnel for peritoneal and mediastinal access from the esophagus and stomach [11][12][13][14]. The tunnel allows the mucosal incision to be separated from the serosal incision by several centimeters, as in a ''Z'' tract.…”

Technique for transesophageal endoscopic cardiomyotomy (Heller myotomy): video presentation at the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) 2008, Philadelphia, PA

“…We hypothesized that our previously described submucosal dissection method, the self-approximating translumenal access technique (STAT) [7,8], would permit performance of a complete cardiomyotomy, including the requisite gastric muscle, via a transesophageal route. The video demonstrates the technical maneuvers required to perform a totally endoscopic transesophageal Heller myotomy in an acute porcine model.…”