Abstract
Background
Several working groups have already demonstrated the feasibility of transgastric surgery procedures using flexible endoscopes. However, technical limitations in natural orifice translumenal endoscopic surgery (NOTES) (e.g., exposure, retraction, insufflations, and triangulation) currently still require the use of at least one external instrument [1–3]. Therefore, “pure NOTES” transgastric cholecystectomy has not yet been described. The authors successfully performed “pure NOTES” transgastric cholecystectomy using a transoral dual-scope technique (similar to the approach the authors previously reported for gastric closure [4]) that allows completion of the procedure by pure NOTES without an external instrument.
Methods
With the subject under general anesthesia, a double-channel gastroscope (Storz®, Tuttlingen, Germany) passed by mouth entered the peritoneum through the distal anterior gastric wall. The most ideal site for a second gastric exit was then selected for another single-channel scope. With the gallbladder retracted by the assistant operating the double-channel scope, retrograde cholecystectomy was performed by the primary surgeon using the single-channel scope. Four animals were killed immediately to study the quality of the operative dissection, whereas the other four pigs were kept alive. The gastrotomy was closed using a 27- to 30-mm cardiac septal occluder (Occlutech®, GmbH, Jena, Germany) according to a previously described method [5]. The postoperative follow-up assessment of these animals included laparoscopy and necropsy 2 weeks later.
Results
All the cholecystectomies were immediately successful without any intraoperative complication. Scope withdrawal caused no injuries to the esophagus or pharynx. Although no overt postoperative complication was evident, two surviving pigs had signs of minor peritoneal infection.
Conclusions
This study investigated “pure NOTES” transgastric cholecystectomy using tentative experimentation to overcome the “retraction” and “triangulation” issues and to realize a “pure NOTES” operation. The use of two endoscopes with selected differentiation of their gastric placements compensated for the lack of triangulation and retraction.
Similar content being viewed by others
References
Perretta S, Dallemagne B, Coumaros D, Marescaux J (2008) Natural orifice transluminal endoscopic surgery: transgastric cholecystectomy in a survival porcine model. Surg Endosc 22(4): 1126–1130
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(4):601–606
Swanstrom LL, Kozarek R, Pasricha PJ, Gross S, Birkett D, Park PO, Saadat V, Ewers R, Swain P (2005) Development of a new access device for transgastric surgery. J Gastrointest Surg 9(8):1129–1136; discussion 1136–1127
Asakuma M, Perretta S, Cahill RA, Solano C, Pasupathy S, Dallemagne B, Tanigawa N, Marescaux J (2009) Peroral dual scope for natural orifice transluminal endoscopic surgery (NOTES) gastrotomy closure. Surg Innov 16(2):97–103
Perretta S, Sereno S, Forgione A, Dallemagne B, Coumaros D, Boosfeld C, Moll C, Marescaux J (2007) A new method to close the gastrotomy by using a cardiac septal occluder: long-term survival study in a porcine model. Gastrointest Endosc 66(4):809–813
Disclosures
Mitsuhiro Asakuma, Silvana Perretta, Pierre Allemann, Ronan Cahill, Bernard Dallemagne, Nobuhiko Tanigawa, and Jacques Marescaux have no conflicts of interest or financial ties to disclose.
Author information
Authors and Affiliations
Corresponding author
Electronic supplementary material
Below is the link to the electronic supplementary material.
Supplementary material 1 (MPG 107728 kb)
Rights and permissions
About this article
Cite this article
Asakuma, M., Perretta, S., Allemann, P. et al. Per-oral dual scope NOTES cholecystectomy in porcine model (with video). Surg Endosc 24, 2624–2625 (2010). https://doi.org/10.1007/s00464-010-0992-3
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-010-0992-3