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

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Abstract

Background

The self-approximating translumenal access technique (STAT) has been shown to provide a safe and reliable means of abdominal access for natural orifice translumenal endoscopic surgery (NOTES). However, the feasibility of using STAT for translumenal organ resection is unknown. This study aimed to evaluate the technical performance of organ resection using STAT, the integrity of the STAT gastric tunnel after organ resection, and the postoperative morbidity of organ resection using STAT.

Methods

In this study, 14 domestic swine underwent transgastric organ resection (7 cholecystectomies, 7 uterine horn resections) followed by sequential removal of two different sizes of standardized specimens. Evaluation of operative injury to the tunnel and difficulty of specimen extraction was performed. After 2 weeks of observation, necropsy was performed for evaluation and documentation of gross findings.

Results

The mean operating room time (intubation recovery) was 4.1 h. A tunnel with a mean length of 12 cm and a mean width of 4 cm was created. The tunnel remained fully intact in 14 of 14 animals after organ resection, in 13 of 13 animals after balloon extraction, and in 12 of 14 animals after rigid specimen extraction (1 clinically significant tear occurred). Postoperatively, all the animals gained weight appropriately. Necropsy findings included adhesions (n = 4), bile leak (n = 2), minor lap-port abscess (n = 1), and ventral hernia (n = 1).

Conclusions

Although this study was a limited, prospective, animal survival study without a control arm, it again indicates that STAT allows safe abdominal access, a reliable means of closure, and directed endoscope positioning. Although one significant mucosal tear did occur, this study suggests STAT will tolerate the mechanical forces of peroral transgastric procedures provided the organ resected is small to moderate in size (<8 × 3 cm).

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Acknowledgment

The authors acknowledge that this project was funded through the generous support of the 2008 NOSCAR-Covidien Research Fund and is in accordance with the guidelines for NOTES research as outlined by SAGES and ASGE, and their support is appreciated.

Disclosures

The Penn State NOTES Working Group has received unrestricted donations of endoscopic equipment and supplies from Olympus Optical Co. and Boston Scientific Inc. At no time were these entities or one of their representatives privy to the results of this investigation or the interpretation of its findings. Matthew T. Moyer, Eric M. Pauli, Jegan Gopal, Abraham Mathew, and Randy S. Haluck no financial relationships with a commercial entity producing health-care related products and/or services relevant to this article.

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Authors and Affiliations

  1. Division of Gastroenterology/Hepatology, Penn State Hershey Medical Center, Hershey, PA, USA

    Matthew T. Moyer & Abraham Mathew

  2. Department of General Surgery, Penn State Hershey Medical Center, Hershey, PA, USA

    Eric M. Pauli

  3. Division of Minimally Invasive Surgery, Penn State Hershey Medical Center, Hershey, PA, USA

    Jegan Gopal & Randy S. Haluck

Authors
  1. Matthew T. Moyer
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  2. Eric M. Pauli
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  3. Jegan Gopal
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  4. Abraham Mathew
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  5. Randy S. Haluck
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Corresponding author

Correspondence to Matthew T. Moyer.

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Moyer, M.T., Pauli, E.M., Gopal, J. et al. Durability of the self-approximating translumenal access technique (STAT) for potential use in natural orifice translumenal surgery (NOTES). Surg Endosc 25, 315–322 (2011). https://doi.org/10.1007/s00464-010-1141-8

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  • DOI: https://doi.org/10.1007/s00464-010-1141-8

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