Transgastric anastomosis by using flexible endoscopy in a porcine model (with video)

Bergström, Maria; Ikeda, Keiichi; Swain, Paul; Park, Per-Ola

doi:10.1016/j.gie.2005.09.035

Cited by 182 publications

(107 citation statements)

References 9 publications

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“…Currently, three types of fullthickness suture devices are under evaluation for perforation closure of stomach and colon: two through-theendoscope devices such as the endoscopic suturing kit (Tfasteners with a locking cinch) and the gProx (USGI Medical, San Clemente, CA, USA), and one over-theendoscope device, the Eagle Claw Suturing Device (Apollo Group and the Olympus Medical Systems, Tokyo, Japan) [11]. The endoscopic suturing kit has been used successfully in different gastrointestinal procedures (perforations after endoluminal gastric or colon resections, transgastric gastrojejunostomy and pyloroplasty, closure of perforated gastric ulcer) both in animals and humans [12][13][14][15][16][17]. Because this method uses equipment that works through a 2.8-mm channel of a standard gastroscope, we hypothesized that we could apply it through a 7F working channel of a cystoscope.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic Closure of Transmural Bladder Wall Perforations

et al. 2009

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Background: Traditionally, intraperitoneal bladder perforations caused by trauma or iatrogenic interventions have been treated by open or laparoscopic surgery. Additionally, transvesical access to the peritoneal cavity has been reported to be feasible and useful for natural orifice translumenal endoscopic surgery (NOTES) but would be enhanced by a reliable method of closing the vesicotomy. Objective: To assess the feasibility and safety of an endoscopic closure method for vesical perforations using a flexible, small-diameter endoscopic suturing kit in a survival porcine model. Design, setting, and participants: This pilot study was performed at the University of Minho, Braga, Portugal, using six anesthetized female pigs. Interventions: Closure of a full-thickness longitudinal incision in the bladder dome (up to 10 mm in four animals and up to 20 mm in two animals) with the endoscopic suturing kit using one to three absorbable stitches. Measurements: The acute quality of sealing was immediately tested by distending the bladder with methylene-blue dye under laparoscopic control (in two animals). Without a bladder catheter, the animals were monitored daily for 2 wk, and a necropsy examination was performed to check for the signs of peritonitis, wound dehiscence, and quality of healing. Results and limitations: Endoscopic closure of bladder perforation was carried out easily and quickly in all animals. The laparoscopic view revealed no acute leak of methylene-blue dye after distension of the bladder. After recovery from anaesthesia, the pigs began to void normally, and no adverse event occurred. Postmortem examination revealed complete healing of vesical incision with no signs of infection or adhesions in the peritoneal cavity. No limitations have yet been studied clinically. Conclusions: This study demonstrates the feasibility and the safety of endoscopic closure of vesical perforations with an endoscopic suturing kit in a survival porcine model. This study provides support for further studies using endoscopic closure of the bladder which may lead to a new era in management of bladder rupture and adoption of the transvesical port in NOTES procedures.

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Section: Discussionmentioning

confidence: 99%

Endoscopic Closure of Transmural Bladder Wall Perforations

et al. 2009

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“…[11][12][13][14][15][16][17] In fact, there are several theoretical advantages to NOTES. 1) There are no abdominal incisions and, therefore, abdominal wound infections and incisional hernias are avoided, possibly resulting in less pain and certainly in a better cosmetic effect.…”

Section: Discussionmentioning

confidence: 99%

Third-Generation Nephrectomy by Natural Orifice Transluminal Endoscopic Surgery

et al. 2007

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Purpose:Recently there has been increasing enthusiasm for performing simple abdominal procedures by transgastric surgery. We previously reported the usefulness of a combined transgastric and transvesical approach to cholecystectomy. In this study we assessed the feasibility of combined transgastric and transvesical approach for performing a more complex surgical procedure, such as nephrectomy, in a porcine model. Materials and Methods: In a nonsurvival study combined transgastric and transvesical approaches were established in 6 female pigs. Under ureteroscope guidance we installed a transvesical 5 mm over tube into the peritoneal cavity and a flexible gastroscope was passed orally into the peritoneal cavity by a gastrotomy. We performed right or left nephrectomy with instruments introduced by the 2 devices that worked in the renal hilum, alternating device intervention for dissection and retraction procedures. Results: Four right and 2 left nephrectomies were performed. There were no complications during the creation of transvesical and transgastric access. In all animals we visualized the 2 kidneys. The renal vessels and ureter were reasonably individualized and ligated separately with ultrasonic scissors, which were introduced through the transvesical port. In 2 early cases mild hemorrhage occurred after ultrasonic ligation. To overcome this complication we applied clips successfully before ultrasonic ligation in the remaining animals. Thus, complete renal release and mobilization to the stomach were achieved in all animals. Conclusions: Nephrectomy by natural orifices using the combined transgastric and transvesical approach is technically feasible, although to our knowledge there is no reliable method for removing the specimen with current instruments.

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“…Several studies have since used the transgastric port for intraperitoneal abdominal procedures, such as fallopian tube ligation, cholecystectomy, gastrojejunostomy, lymphadenectomy, oophorectomy, partial hysterectomy, splenectomy, appendectomy, and diaphragmatic pacing [6][7][8][9][10][11][12][13][14][15]23]. Following the initial enthusiasm, however, abdominal procedures through isolated transgastric routes raised limitations that jeopardized application in humans.…”

Section: Experimental Studiesmentioning

confidence: 99%

“…These developments marked a new era in minimally invasive abdominal surgery, compelling novel, previously audacious goals, such as avoidance of incisions and pain. With the visceral wall no longer a barrier to endoscopic intervention, various authors described novel, complex abdominal procedures [6][7][8][9][10][11][12][13][14][15][16]. In 2006, such reports motivated researchers in this emerging field to organize the Natural Orifice Surgery Consortium for Assessment and Research (NOSCAR), a joint initiative supported by the American Society for Gastrointestinal Endoscopy (AGES) and the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES).…”

Section: Introductionmentioning

confidence: 99%

Transvesical endoscopic peritoneoscopy: Intra-abdominal scarless surgery for urologic applications

Lima¹,

Rolanda²,

Correia‐Pinto

2008

Curr Urol Rep

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For many abdominal procedures, advantages such as minimal scarring, reduced pain, and faster recovery have made laparoscopy the favored approach over traditional open surgery. The most recent minimally invasive approach is natural orifice transluminal endoscopic surgery (NOTES), which limits morbidity because this surgery does not require incision. This article reviews the history, development, and current and future applications of NOTES in the field of urology.

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Transgastric anastomosis by using flexible endoscopy in a porcine model (with video)

Cited by 182 publications

References 9 publications

Endoscopic Closure of Transmural Bladder Wall Perforations

Endoscopic Closure of Transmural Bladder Wall Perforations

Third-Generation Nephrectomy by Natural Orifice Transluminal Endoscopic Surgery

Transvesical endoscopic peritoneoscopy: Intra-abdominal scarless surgery for urologic applications

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