Single-incision flexible endoscopy (SIFE) for detection and staging of peritoneal carcinomatosis
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To show the feasibility and the safety of peritoneal carcinomatosis (PC) evaluation by single-incision flexible endoscopy (SIFE) and to compare it to single-incision rigid endoscopy (SIRE).
Direct peritoneal visualization, either by laparotomy or laparoscopy, continues to be the gold standard in diagnosing PC. We reported, in animal study, that combining single-incision laparoscopic surgery and flexible endoscopy improved evaluation of the peritoneal cavity in a live porcine model and in four human cadavers.
Patients, undergoing surgical exploration for diagnosis and staging of PC, were included in a prospective study. Using a superiority design a sample size of 47 patients was determined. Through a single incision, a standardized peritoneoscopy was conducted with rigid (SIRE) and with flexible endoscope (SIFE). Primary outcome was the access success rates for the 13 regions of the Peritoneal Carcinomatosis Index (PCI).
Overall access to the 13 regions of PCI was successful in 83 % of the cases with SIRE and in 91.1 % with SIFE (p < 10−10). SIFE access rates were superior to SIREs’ in the regions: R1 (87.2 vs. 61.7 %, p = 0.002), R2 (87.2 vs. 66 %, p = 0.004), R3 (85.1 vs. 59.6 %, p = 0.001) and R6 (80.9 vs. 61.7 %, p = 0.008). The mean PCI was higher (p < 104) with SIFE 12.77 (±11.97) than with SIRE 11.77 (±11.63).
This prospective, comparative study shows that SIFE was significantly superior to SIRE in the exploration of some difficult-to-access peritoneal areas, located in regions 1, 2, 3 and 6. These two minimally invasive staging procedures are safe, feasible and have to be seen as complementary rather than competing.
KeywordsMinimally invasive surgery Single-incision laparoscopic surgery Peritoneal carcinomatosis Peritoneoscopy Laparoendoscopic single-site surgery
Compliance with ethical standards
Fujifilm Medical System Company paid the inscription and the travel to the «United European Gastroenterology Week» which took place in Stockholm in October 2011. Two members of the team were present for poster presentation (Drs. R. Lo Dico and Dr. X. Dray). It is also a partner to the INSERM U965 Unit to study impact of endoscopy on evaluation of peritoneal carcinomatosis. Drs. M. Grienay, A. Dohan, H. Najah and M. Pocard have no conflicts of interest or financial ties to disclose.
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