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Reliability of gastric access closure with the self-approximating transluminal access technique (STAT) for NOTES

  • Endoluminal Surgery
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Abstract

Background

STAT, or the self-approximating transluminal access technique, has been previously described and involves the dissection of a submucosal tunnel for peritoneal or mediastinal access from the esophagus and stomach. The objective of this study was to assess the safety and reliability of gastric access and closure in a porcine experience using STAT for natural orifice transluminal endoscopic surgery (NOTES).

Methods

A review of the experience using STAT access tunnels for intraperitoneal access was performed in 39 female pigs at a university animal lab. All animals underwent a predetermined NOTES surgical procedure using a STAT transgastric access tunnel based on a specific protocol. Details of the procedure, complications, and clinical course were documented. Necropsy was performed at 2 weeks. The main outcome measurements were clinical or necropsy evidence of gastrostomy site leak or inadequate access site closure.

Results

STAT was successful in providing safe peritoneal access in all animals. The width of the tunnel ranged from 1.5 to 5.5 cm and the length was up to 27 cm. There was no evidence of gastrostomy site leak in any animals. One animal required a single laparoscopic suture to help with tunnel closure.

Conclusion

STAT provides safe transgastric access and allows secure closure of the gastrotomy site.

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Acknowledgments

We thank the dedicated staff of the Department of Comparative Medicine (Dr. Ronald Wilson and Ms. Joy Ellwanger). We also acknowledge support from Olympus Endoscopy for routine and prototype scopes and accessories, Boston Scientific for endoscopic accessories, and Pentax USA for endoscopes. Protocol 2 was supported by a grant from SAGES, protocol 3 was supported by a grant from NOSCAR, protocol 4 was funded by Life Cell Corporation, and protocol 5 by supported a grant from Association of Women Surgeons.

Conflict of interest

None.

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Authors and Affiliations

  1. Division of Gastroenterology, Penn State Hershey Medical Center and Penn State College of Medicine, Hershey, PA, 17033, USA

    Abraham Mathew, Matthew T. Moyer & Brooke B. Ancrile

  2. Division of Minimally Invasive Surgery, Penn State Hershey Medical Center and College of Medicine, Hershey, PA, 17033, USA

    Jonathan M. Tomasko, Eric M. Pauli, Jegan Gopal, Ann M. Rogers & Randy S. Haluck

Authors
  1. Abraham Mathew
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  2. Jonathan M. Tomasko
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  3. Eric M. Pauli
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  4. Matthew T. Moyer
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  5. Jegan Gopal
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  6. Brooke B. Ancrile
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  7. Ann M. Rogers
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  8. Randy S. Haluck
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Corresponding author

Correspondence to Abraham Mathew.

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Mathew, A., Tomasko, J.M., Pauli, E.M. et al. Reliability of gastric access closure with the self-approximating transluminal access technique (STAT) for NOTES. Surg Endosc 25, 2718–2724 (2011). https://doi.org/10.1007/s00464-011-1659-4

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  • DOI: https://doi.org/10.1007/s00464-011-1659-4

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