Surgical Endoscopy

, Volume 21, Issue 6, pp 998–1001

Comparison of intraabdominal pressures using the gastroscope and laparoscope for transgastric surgery

  • O. Meireles
  • S. V. Kantsevoy
  • A. N. Kalloo
  • S. B. Jagannath
  • S. A. Giday
  • P. Magno
  • S. P. Shih
  • E. J. Hanly
  • C. -W. Ko
  • D. M. Beitler
  • M. R. Marohn
Article

Abstract

Background

The peroral transgastric endoscopic approach for intraabdominal procedures appears to be feasible, although multiple aspects of this approach remain unclear. This study aimed to measure intraperitoneal pressure in a porcine model during the peroral transgastric endoscopic approach, comparing an endoscopic on-demand insufflator/light source with a standard autoregulated laparoscopic insufflator.

Methods

All experiments were performed with 50-kg female pigs under general anesthesia. A standard upper endoscope was advanced perorally through a gastric wall incision into the peritoneal cavity. The peritoneal cavity was insufflated with operating room air from an endoscopic light source/insufflator. Intraperitoneal pressure was measured by three routes: (1) through the endoscope biopsy channel, (2) through a 5-mm transabdominal laparoscopic port, and (3) through a 16-gauge Veress needle inserted into the peritoneal cavity through the anterior abdominal wall. The source of insufflation alternated between on-demand manual insufflation through the endoscopic light source/insufflator using room air and a standard autoregulated laparoscopic insufflator using carbon dioxide (CO2).

Results

Six acute experiments were performed. Intraperitoneal pressure measurements showed good correlation regardless of measurement route and were independent of the type of insufflation gas, whether room air or CO2. On-demand insufflation with the endoscopic light source/insufflator resulted in a wide variation in pressures (range, 4–32 mmHg; mean, 16.0 ± 11.7). Intraabdominal pressures using a standard autoregulated laparoscopic insufflator demonstrated minimal fluctuation (range, 8–15 mmHg; mean, 11.0 ± 2.2 mmHg) around a predetermined value.

Conclusion

Use of an on-demand unregulated endoscopic light source/insufflator for translumenal surgery can cause large variation in intraperitoneal pressures and intraabdominal hypertension, leading to the risk of hemodynamic and respiratory compromise. Safety may favor well-controlled intraabdominal pressures achieved with a standard autoregulated laparoscopic insufflator.

Keywords

Autoregulated laparoscopic insufflator Endoscopic on-demand insufflator/light source Intraabdominal pressure Intraperitoneal pressure Peroral transgastric endoscopic approach PTE NOTES 

References

  1. 1.
    Barnes GE, Laine GA, Giam PY, Smith EE, Granger HJ (1985) Cardiovascular responses to elevation of intraabdominal hydrostatic pressure. Am J Physiol 248: R209Google Scholar
  2. 2.
    Bergstrom M, Ikeda K, Swain P, Park PO (2006) Transgastric anastomosis by using flexible endoscopy in a porcine model (with video). Gastrointest Endosc 63: 307–312PubMedCrossRefGoogle Scholar
  3. 3.
    Booker WM, French DM, Molano PA (1947) Further studies on the acute effects of intraabdominal pressure. Am J Physiol 149: 92–98Google Scholar
  4. 4.
    Brunt LM, Langer JC, Quasebarth MA, Whitman ED (1996) Comparative analysis of laparoscopic versus open splenectomy. Am J Surg 172: 596–599, discussion 599–601PubMedCrossRefGoogle Scholar
  5. 5.
    Hanly EJ, Mendoza-Sagaon M, Murata K, Hardacre JM, DeMaio A, Talamini MA (2003) CO2 pneumoperitoneum modifies the inflammatory response to sepsis. Ann Surg 237: 343–350PubMedCrossRefGoogle Scholar
  6. 6.
    Ikechebelu JI, Obi RA, Udigwe GO, Joe-Ikechebelu NN (2005) Comparison of carbon dioxide and room air pneumoperitoneum for day-case diagnostic laparoscopy. J Obstet Gynaecol 25: 172–173PubMedCrossRefGoogle Scholar
  7. 7.
    Jagannath SB, Kantsevoy SV, Vaughn CA, Chung SS, Cotton PB, Gostout CJ, Hawes RH, Pasricha PJ, Scorpio DG, Magee CA, Pipitone LJ, Kalloo AN (2005) Peroral transgastric endoscopic ligation of fallopian tubes with long-term survival in a porcine model. Gastrointest Endosc 61: 449–453PubMedCrossRefGoogle Scholar
  8. 8.
    Joris JL, Noirot DP, Legrand MJ, Jacquet NJ, Lamy ML (1993) Haemodynamic changes during laparoscopic cholecystectomy. Anesth Analg 76: 1067–1071PubMedCrossRefGoogle Scholar
  9. 9.
    Kalloo AN, Singh VK, Jagannath SB, Niiyama H, Hill SL, Vaughn CA, Magee CA, Kantsevoy SV (2004) Flexible transgastric peritoneoscopy: a novel approach to diagnostic and therapeutic interventions in the peritoneal cavity. Gastrointest Endosc 60: 114–117PubMedCrossRefGoogle Scholar
  10. 10.
    Kantsevoy SV, Hu B, Jagannath SB, Vaughn CA, Beitler DM, Chung SS, Cotton PB, Gostout CJ, Hawes RH, Pasricha PJ, Magee CA, Pipitone LJ, Talamini MA, Kalloo AN (2006) Transgastric endoscopic splenectomy: Is it possible? Surg Endosc 20(3): 522–5Google Scholar
  11. 11.
    Kantsevoy SV, Jagannath SB, Niiyama H, Chung SS, Cotton PB, Gostout CJ, Hawes RH, Pasricha PJ, Magee CA, Barlow D, Shimonaka H, Kalloo AN (2005) Endoscopic gastrojejunostomy with survival in a porcine model. Gastrointest Endosc 62: 287–292PubMedCrossRefGoogle Scholar
  12. 12.
    Morales-Conde S, Cadet H, Cano A, Bustos M, Martin J, Morales-Mendez S (2005) Laparoscopic ventral hernia repair without sutures—double crown technique: our experience after 140 cases with a mean follow-up of 40 months. Int Surg 90: S56–S62PubMedGoogle Scholar
  13. 13.
    Muckleroy SK, Ratzer ER, Fenoglio ME (1999) Laparoscopic colon surgery for benign disease: a comparison to open surgery. JSLS 3: 33–37PubMedGoogle Scholar
  14. 14.
    Odeberg S, Ljungqvist O, Svenberg T, Gannedahl P, Backdahl M, Von Rosen A, Sollevi A (1994) Haemodynamic effects of pneumoperitoneum and the influence of posture during anaesthesia for laparoscopic surgery. Acta Anaesthesiol Scand 38: 276–283Google Scholar
  15. 15.
    Park PO, Bergstrom M, Ikeda K, Fritscher-Ravens A, Swain P (2005) Experimental studies of transgastric gallbladder surgery: cholecystectomy and cholecystogastric anastomosis (videos). Gastrointest Endosc 61: 601–606PubMedCrossRefGoogle Scholar
  16. 16.
    Rattner D, Kalloo A (2006) ASGE/SAGES Working Group on Natural Orifice Translumenal Endoscopic Surgery. October 2005. Surg Endosc 20: 329–333Google Scholar
  17. 17.
    Wagh MS, Merrifield BF, Thompson CC (2005) Endoscopic transgastric abdominal exploration and organ resection: initial experience in a porcine model. Clin Gastroenterol Hepatol 3: 892–896PubMedCrossRefGoogle Scholar
  18. 18.
    Wagh MS, Merrifield BF, Thompson CC (2006) Survival studies after endoscopic transgastric oophorectomy and tubectomy in a porcine model. Gastrointest Endosc 63: 473–478PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  • O. Meireles
    • 1
  • S. V. Kantsevoy
    • 2
  • A. N. Kalloo
    • 2
  • S. B. Jagannath
    • 2
  • S. A. Giday
    • 2
  • P. Magno
    • 2
  • S. P. Shih
    • 1
  • E. J. Hanly
    • 1
  • C. -W. Ko
    • 2
  • D. M. Beitler
    • 2
  • M. R. Marohn
    • 1
  1. 1.Department of SurgeryJohns Hopkins University School of MedicineBaltimoreUSA
  2. 2.Division of GastroenterologyJohns Hopkins University School of MedicineBaltimoreUSA

Personalised recommendations