Surgical Endoscopy

, Volume 24, Issue 6, pp 1440–1446 | Cite as

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

  • Peter Nau
  • Joel Anderson
  • Benjamin Yuh
  • Peter MuscarellaJr.
  • E. Christopher Ellison
  • Lynn Happel
  • Vimal K. Narula
  • W. Scott Melvin
  • Jeffrey W. Hazey
Article

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 surgery Natural orifice translumenal endoscopic surgery Transgastric surgery 

References

  1. 1.
    Semm K (1983) Endoscopic appendectomy. Endoscopy 15:59–64CrossRefPubMedGoogle Scholar
  2. 2.
    Allemann P, Perretta S, Asakuma M, Dallemagne B, Mutter D, Marescaux J (2009) NOTES retroperitoneal transvaginal distal pancreatectomy. Multimedia manuscript. Surg Endosc 23:882–883CrossRefPubMedGoogle Scholar
  3. 3.
    Isariyawongse JP, McGee MF, Rosen MJ, Cherullo EE, Ponsky LE (2008) Pure natural orifice transluminal endoscopic surgery (NOTES) nephrectomy using standard laparoscopic instruments in the porcine model. J Endourol 22:1087–1091CrossRefPubMedGoogle Scholar
  4. 4.
    Leroy J, Cahill RA, Perretta S, Forgione A, Dallemagne B, Marescaux J (2009) Natural orifice translumenal endoscopic surgery (NOTES) applied totally to sigmoidectomy: an original technique with survival in a porcine model. Surg Endosc 23:24–30CrossRefPubMedGoogle Scholar
  5. 5.
    Simopoulos C, Kouklakis G, Zezos P, Ypsilantis P, Botaitis S, Tsalikidis C, Pitiakoudis M (2009) Peroral transgastric endoscopic procedures in pigs: feasibility, survival, questionings, and pitfalls. Surg Endosc 23:394–402CrossRefPubMedGoogle Scholar
  6. 6.
    ASGE/SAGES Working Group on Natural Orifice Translumenal Endoscopic Surgery (2006) White paper October 2005. Gastrointest Endosc 63:199–203Google Scholar
  7. 7.
    Narula VK, Hazey JW, Renton DB, Reavis KM, Paul CM, Hinshaw KE, Needleman BJ, Mikami DJ, Ellison EC, Melvin WS (2008) Transgastric instrumentation and bacterial contamination of the peritoneal cavity. Surg Endosc 22:605–611CrossRefPubMedGoogle Scholar
  8. 8.
    Hazey JW, Narula VK, Renton DB, Reavis KM, Paul CM, Hinshaw KE, Muscarella P, Ellison EC, Melvin WS (2008) Natural-orifice transgastric endoscopic peritoneoscopy in humans: initial clinical trial. Surg Endosc 22:16–20CrossRefPubMedGoogle Scholar
  9. 9.
    Meireles O, Kantsevoy SV, Kalloo AN, Jagannath SB, Giday SA, Magno P, Shih SP, Hanly EJ, Ko CW, Beitler DM, Marohn MR (2007) Comparison of intraabdominal pressures using the gastroscope and laparoscope for transgastric surgery. Surg Endosc 21:998–1001CrossRefPubMedGoogle Scholar
  10. 10.
    de Sousa LH, de Sousa JA, de Sousa Filho LH, de Sousa MM, de Sousa VM, de Sousa AP, Zorron R (2009) Totally NOTES (T-NOTES) transvaginal cholecystectomy using two endoscopes: preliminary report. Surg Endosc [Epub ahead of print]Google Scholar
  11. 11.
    Decarli L, Zorron R, Branco A, Lima FC, Tang M, Pioneer SR, Zanin I Jr, Schulte AA, Bigolin AV, Gagner M (2008) Natural orifice translumenal endoscopic surgery (NOTES) transvaginal cholecystectomy in a morbidly obese patient. Obes Surg 18:886–889CrossRefPubMedGoogle Scholar
  12. 12.
    Navarra G, Rando L, La Malfa G, Bartolotta G, Pracanica G (2009) Hybrid transvaginal cholecystectomy: a novel approach. Am J Surg 197(6):e69–e72CrossRefPubMedGoogle Scholar
  13. 13.
    Palanivelu C, Rajan PS, Rangarajan M, Parthasarathi R, Senthilnathan P, Prasad M (2008) Transvaginal endoscopic appendectomy in humans: a unique approach to NOTES: world’s first report. Surg Endosc 22:1343–1347CrossRefPubMedGoogle Scholar
  14. 14.
    Palanivelu C, Rajan PS, Rangarajan M, Prasad M, Kalyanakumari V, Parthasarathi R, Senthilnathan P (2009) NOTES: transvaginal endoscopic cholecystectomy in humans: preliminary report of a case series. Am J Gastroenterol 104(4):843–847CrossRefPubMedGoogle Scholar
  15. 15.
    Ramos AC, Murakami A, Galvao Neto M, Galvao MS, Silva AC, Canseco EG, Moyses Y (2008) NOTES transvaginal video-assisted cholecystectomy: first series. Endoscopy 40:572–575CrossRefPubMedGoogle Scholar
  16. 16.
    Zorron R, Filgueiras M, Maggioni LC, Pombo L, Lopes Carvalho G, Lacerda Oliveira A (2007) NOTES. Transvaginal cholecystectomy: report of the first case. Surg Innov 14:279–283CrossRefPubMedGoogle Scholar
  17. 17.
    Zorron R, Maggioni LC, Pombo L, Oliveira AL, Carvalho GL, Filgueiras M (2008) NOTES transvaginal cholecystectomy: preliminary clinical application. Surg Endosc 22:542–547CrossRefPubMedGoogle Scholar
  18. 18.
    Varadarajulu S, Tamhane A, Drelichman ER (2008) Patient perception of natural orifice transluminal endoscopic surgery as a technique for cholecystectomy. Gastrointest Endosc 67:854–860CrossRefPubMedGoogle Scholar
  19. 19.
    Auyang ED, Hungness ES, Vaziri K, Martin JA, Soper NJ (2009) Human NOTES cholecystectomy: transgastric hybrid technique. J Gastrointest Surg 13(6):1149–1150CrossRefPubMedGoogle Scholar
  20. 20.
    Bessler M, Stevens PD, Milone L, Parikh M, Fowler D (2007) Transvaginal laparoscopically assisted endoscopic cholecystectomy: a hybrid approach to natural orifice surgery. Gastrointest Endosc 66:1243–1245CrossRefPubMedGoogle Scholar
  21. 21.
    Forgione A, Maggioni D, Sansonna F, Ferrari C, Di Lernia S, Citterio D, Magistro C, Frigerio L, Pugliese R (2008) Transvaginal endoscopic cholecystectomy in human beings: preliminary results. J Laparoendosc Adv Surg Tech A 18:345–351CrossRefPubMedGoogle Scholar
  22. 22.
    Fong DG, Ryou M, Pai RD, Tavakkolizadeh A, Rattner DW, Thompson CC (2007) Transcolonic ventral wall hernia mesh fixation in a porcine model. Endoscopy 39:865–869CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Peter Nau
    • 1
  • Joel Anderson
    • 1
  • Benjamin Yuh
    • 1
  • Peter MuscarellaJr.
    • 1
  • E. Christopher Ellison
    • 2
  • Lynn Happel
    • 3
  • Vimal K. Narula
    • 1
  • W. Scott Melvin
    • 4
  • Jeffrey W. Hazey
    • 1
  1. 1.Division of General SurgeryThe Ohio State University School of Medicine and Public HealthColumbusUSA
  2. 2.Department of SurgeryThe Ohio State University School of Medicine and Public HealthColumbusUSA
  3. 3.Department of SurgeryUniversity Physician Associates, Truman Medical CenterKansas CityUSA
  4. 4.Center for Minimally Invasive SurgeryThe Ohio State University School of Medicine and Public HealthColumbusUSA

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