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A review of 130 humans enrolled in transgastric NOTES protocols at a single institution

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Abstract

Background

The methodology of Natural Orifice Translumenal Endoscopic Surgery (NOTES) has been validated in both human and animal models. Herein is a discussion of our experience gained from the initial 130 patients enrolled in transgastric pre-NOTES and NOTES protocols at our institution.

Methods

A retrospective review of our research database was performed for all patients enrolled in NOTES protocols. The infectious risk of a gastrotomy with and without a NOTES procedure was assessed in 100 patients. Eighty patients completed a true NOTES protocol looking at staging, access, and insufflation with select patients evaluating the potential for bacterial contamination of the abdominal compartment.

Results

A total of 130 patients have completed pre-NOTES and NOTES protocols at our institution. We observed no clinically significant contamination of the abdomen secondary to transgastric procedures in 100 patients. Diagnostic transgastric endoscopic peritoneoscopy (DTEP) was completed in 20 patients with pancreatic head masses and found to have a 95% concordance with laparoscopic exploration for assessment of peritoneal metastases. Blind endoscopic gastrotomy and DTEP were evaluated in 40 patients who underwent laparoscopic Roux-en-Y gastric bypass procedures (LSRYGB) and were found to be safe, reliable, and without a clinically significant risk of contamination. Endoscopic peritoneal insufflation was successfully established and correlated with standard laparoscopic insufflation in 20 patients.

Conclusions

Transgastric NOTES is a safe alternative approach to accessing the peritoneal cavity in humans. The risk of bacterial contamination secondary to peroral and transgastric access is clinically insignificant. A device for the facile closure of the gastric defect is the sole factor limiting institution of this methodology as a standalone technique.

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Disclosures

E. Christopher Ellison, Peter Muscarella, Jr., Dean Mikami, Vimal K. Narula, Bradley Needleman, W. Scott Melvin, Jeffrey W. Hazey. Peter Nau, MD, received a Covidien Training Grant. W. Scott Melvin, MD, serves on the Advisory Board for Endogastric Solutions, Surgiquest and Stryker. He also received Training Grants from Covidien and Stryker. Dean Mikami, MD, is a consultant for Covidien, Gore and Endogastric solutions. Bradley Needleman, MD, received a Covidien Research Grant. Jeffrey W. Hazey, MD, received a Stryker Research Grant, a Boston Scientific Training Grant, and is on the Clinical Advisory Board for Covidien and Ethicon. Peter Muscarella, Jr., MD, Vimal K. Narula, MD, Benjamin Yuh, Joel Anderson, MD, E. Christopher Ellison, MD, Lynn Happel, MD, and Ron Memark, MD, have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Division of General Surgery, The Ohio State University School of Medicine and Public Health, 410 West 10th Avenue, Columbus, OH, 43210-1228, USA

    Peter Nau, Peter Muscarella Jr., Vimal K. Narula & Jeffrey W. Hazey

  2. Center for Minimally Invasive Surgery, The Ohio State University School of Medicine and Public Health, 410 West 10th Avenue, Columbus, OH, 43210-1228, USA

    Dean Mikami, Bradley Needleman & W. Scott Melvin

  3. Department of Surgery, The Ohio State University School of Medicine and Public Health, 410 West 10th Avenue, Columbus, OH, 43210-1228, USA

    E. Christopher Ellison

  4. Department of Surgery, The Ohio State University Medical Center, N724 Doan Hall, 410 West 10th Avenue, Columbus, OH, 43210-1228, USA

    Jeffrey W. Hazey

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  1. Peter Nau
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  2. E. Christopher Ellison
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Correspondence to Jeffrey W. Hazey.

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Nau, P., Ellison, E.C., Muscarella, P. et al. A review of 130 humans enrolled in transgastric NOTES protocols at a single institution. Surg Endosc 25, 1004–1011 (2011). https://doi.org/10.1007/s00464-010-1369-3

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  • DOI: https://doi.org/10.1007/s00464-010-1369-3

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