Surgical Endoscopy

, Volume 24, Issue 6, pp 1440–1446

Diagnostic transgastric endoscopic peritoneoscopy: extension of the initial human trial for staging of pancreatic head masses

Authors

  • Peter Nau
    • Division of General SurgeryThe Ohio State University School of Medicine and Public Health
  • Joel Anderson
    • Division of General SurgeryThe Ohio State University School of Medicine and Public Health
  • Benjamin Yuh
    • Division of General SurgeryThe Ohio State University School of Medicine and Public Health
  • Peter MuscarellaJr.
    • Division of General SurgeryThe Ohio State University School of Medicine and Public Health
  • E. Christopher Ellison
    • Department of SurgeryThe Ohio State University School of Medicine and Public Health
  • Lynn Happel
    • Department of SurgeryUniversity Physician Associates, Truman Medical Center
  • Vimal K. Narula
    • Division of General SurgeryThe Ohio State University School of Medicine and Public Health
  • W. Scott Melvin
    • Center for Minimally Invasive SurgeryThe Ohio State University School of Medicine and Public Health
    • Division of General SurgeryThe Ohio State University School of Medicine and Public Health
Article

DOI: 10.1007/s00464-009-0797-4

Cite this article as:
Nau, P., Anderson, J., Yuh, B. et al. Surg Endosc (2010) 24: 1440. doi:10.1007/s00464-009-0797-4

Abstract

Background

The validity of natural orifice translumenal endoscopic surgery (NOTES) was confirmed in a human trial of 10 patients undergoing diagnostic transgastric endoscopic peritoneoscopy (DTEP) for staging of pancreatic head masses. This report is an update with 10 additional patients in the series and includes bacterial contamination data.

Methods

The patients in this human trial were scheduled to undergo diagnostic laparoscopy for abdominal staging of a pancreatic head mass. A second surgeon, blinded to the laparoscopic findings, performed a transgastric endoscopic peritoneoscopy (TEP). The findings of laparoscopic exploration were compared with that those of the TEP. Diagnostic findings, operative times, and clinical course were recorded. Bacterial contamination data were collected for the second cohort of 10 patients. Bacterial samples were collected from the scope before use and the abdominal cavity before and after creation of the gastrotomy. Samples were assessed for bacterial counts and species identification. Definitive care was rendered based on the findings from laparoscopy.

Results

In this study, 20 patients underwent diagnostic laparoscopy followed by DTEP. The average time for completion of diagnostic laparoscopy was 10 min compared with 21 min for TEP. The experience acquired during the initial 10 procedures translated to a 7-min decrease in TEP time for the second 10 cases. For 19 of the 20 patients, DTEP corroborated laparoscopic findings for surgical decision making. One endoscopic and five laparoscopic biopsies were performed. Pancreaticoduodenectomy was performed for 14 patients and palliative gastrojejunostomy for 6 patients. No cross-contamination of the peritoneum or infectious complications were noted. No significant complications related to either the endoscopic or laparoscopic approach occurred.

Conclusions

This study supports the authors’ previous conclusions that the transgastric approach to diagnostic peritoneoscopy is feasible, safe, and accurate. The lack of documented bacterial contamination further supports the use of this technique. Technical issues, including intraabdominal manipulation and gastric closure, require further investigation.

Keywords

Endolumenal surgeryNatural orifice translumenal endoscopic surgeryTransgastric surgery

Copyright information

© Springer Science+Business Media, LLC 2010