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Surgical Endoscopy

, Volume 25, Issue 8, pp 2725–2730 | Cite as

Endoscopic access to and exploration of the lesser sac in a human cadaver model: opportunity for transgastric endoscopic pancreatic surgery (with video)

  • B. Joseph ElmunzerEmail author
  • Christopher J. Sonnenday
  • Jason R. Taylor
  • Joseph P. Furlan
  • Steve J. Schomisch
  • James M. Scheiman
  • Amitabh Chak
  • Jeffrey M. Marks
  • Jeffrey L. Ponsky
Dynamic Manuscript

Abstract

Background

Transgastric endoscopy may represent a viable platform for diagnostic and therapeutic pancreatic interventions with reduced morbidity. In a human cadaver model, we aimed to determine the feasibility of transgastric endoscopic access to the lesser sac, creation of an adequate working space within the lesser sac, and reliable identification of lesser sac anatomic structures.

Methods

In six human cadavers, endoscopic guidance was used to determine an appropriate access site to the lesser sac. Subsequently, endosonographic guidance was used to introduce an aspiration needle into the potential space between the stomach and the pancreas. After creating a fluid cushion and dilating the needle tract, an endoscope was advanced through the gastrotomy into the lesser sac and air insufflation was used to create a working space. Predetermined anatomic structures were systematically sought and marked when recognized. In the final two cadavers, endoscopic closure of the access site was performed.

Results

All six procedures were successful in achieving access to the lesser sac and establishing an adequate working space. The access sites appeared amenable to endoscopic closure. Reliable organ identification, however, was not achieved in all cases, representing one of the immediate barriers to clinical application.

Conclusions

Transgastric endoscopic access to the lesser sac can be achieved reliably and an adequate working space can be established. Additional research addressing endoscopic orientation and organ recognition within the lesser sac is necessary. The immediate potential applications of this approach include differentiating benign from malignant pancreatic pathology.

Keywords

NOTES Transgastric endoscopy Pancreatic surgery 

Abbreviations

ERCP

Endoscopic retrograde cholangiopancreatography

EUS

Endoscopic ultrasound

FNA

Fine-needle aspiration

NOTES

Natural orifice transluminal endoscopic surgery

Notes

Disclosures

Amitabh Chak receives research support from Olympus America. Jeffrey Marks sits on the physician advisory board for Apollo Endosurgery. B. Joseph Elmunzer, Christopher J. Sonnenday, Jason R. Taylor, Joseph P. Furlan, Steve Schomisch, James M. Scheiman, and Jeffrey L. Ponsky have no conflicts of interest to declare. No financial support was used for this project. The endoscopes were provided by Olympus Medical Systems. The endoscopic suturing device was provided by Apollo Endosurgery. The endoscopic instruments were provided by Cook Medical, Boston Scientific, Inc., and Olympus America.

Supplementary material

Supplementary material 1 (M4V 98316 kb)

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Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • B. Joseph Elmunzer
    • 1
    Email author
  • Christopher J. Sonnenday
    • 2
  • Jason R. Taylor
    • 1
  • Joseph P. Furlan
    • 3
  • Steve J. Schomisch
    • 3
  • James M. Scheiman
    • 1
  • Amitabh Chak
    • 4
  • Jeffrey M. Marks
    • 3
  • Jeffrey L. Ponsky
    • 3
  1. 1.Division of GastroenterologyUniversity of Michigan Medical CenterAnn ArborUSA
  2. 2.Department of SurgeryUniversity of Michigan Medical CenterAnn ArborUSA
  3. 3.Department of SurgeryUniversity Hospitals Case Medical CenterClevelandUSA
  4. 4.Division of GastroenterologyUniversity Hospitals Case Medical CenterClevelandUSA

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