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Development of a pancreatic tumor animal model and evaluation of NOTES tumor enucleation

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Abstract

Background

Laparoscopic distal pancreatectomy is associated with high morbidity and mortality. NOTES tumor enucleation may provide an alternative to laparoscopic distal pancreatectomy. The goal of this study was to determine the feasibility of NOTES tumor creation and enucleation as a multidisciplinary approach.

Methods

A linear-array endoscopic ultrasound (EUS) endoscope was used to inject a thermosensitive ABA triblock polymer mixed with methylene blue through the stomach wall and into the distal pancreas using a 22-gauge EUS needle. Due to its thermosensitive character, the polymer solidifies in response to body temperature, creating an artificial tumor. Seventeen swine underwent NOTES transgastric pancreatic tumor enucleation. Nine nonsurvival animals were sacrificed immediately after the NOTES procedure, with subsequent necropsy. Eight survival animals were observed for up to 16 days after the procedure, subsequently sacrificed, followed by necropsy.

Results

The procedure was performed successfully in all 17 pigs studied, 9/9 nonsurvival (100%) and 8/8 survival (100%) animals, using a pure NOTES approach without any laparoscopic ports. Complications included two esophageal dissections (1 in nonsurvival group, 1 in survival group) caused by the introduction of the endoscopic overtube (2/17, 12%), unrelated to the actual surgical procedure. In the survival animals, there were two small splenic lacerations caused during retraction with the endoscopic forceps, for which hemostasis was achieved prior to closure of the gastrotomy (2/7, 29%). At necropsy of the animals, there was sufficient closure of 15/17 gastrotomy sites (88%).

Conclusions

The creation of artificial pancreatic tumors via EUS guidance is feasible. Pancreatic tumor enucleation using a transgastric NOTES approach is technically feasible and could be an alternative to laparoscopic distal pancreatectomy with further development. Further adoption and adaptation of this technique will require the development of more sophisticated specialized tools to improve the safety profile of the procedure.

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Acknowledgment

This study was funded with support from a Covidien NOSCAR® Research Award. Olympus America, Inc. (Center Valley, PA) provided material support.

Disclosures

Dr. Matthes holds a management position with Endosim, LLC (Berlin, MA), and has worked as a consultant for Olympus America, Inc. (Center Valley, PA), and Ovesco, Inc (Germany). Drs. Thakkar, Lee, Gromski, Lim, Janschek, S. Jones, D. Jones, and Chuttani have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Division of Gastroenterology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Dana 501, Boston, MA, 02215, USA

    Kai Matthes, Mark A. Gromski & Ram Chuttani

  2. Department of Anesthesiology, Perioperative and Pain Medicine, Children’s Hospital Boston, Harvard Medical School, Boston, MA, 02115, USA

    Kai Matthes

  3. Division of Gastroenterology, Department of Medicine, West Penn Allegheny Health System, Drexel University College of Medicine, Pittsburgh, PA, 15212, USA

    Shyam J. Thakkar

  4. Division of Gastroenterology, Department of Medicine, Soon Chun Hyang University College of Medicine, Cheonan, Korea

    Suck-Ho Lee

  5. Department of Surgery, Tripler Army Medical Center, Honolulu, HI, 96859, USA

    Robert B. Lim

  6. University Hospital Carl Gustav Carus, Technical University of Dresden, Dresden, Germany

    Johannes Janschek

  7. Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, 02215, USA

    Stephanie B. Jones

  8. Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, 02215, USA

    Daniel B. Jones

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  1. Kai Matthes
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Correspondence to Kai Matthes.

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Matthes, K., Thakkar, S.J., Lee, SH. et al. Development of a pancreatic tumor animal model and evaluation of NOTES tumor enucleation. Surg Endosc 25, 3191–3197 (2011). https://doi.org/10.1007/s00464-011-1686-1

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  • DOI: https://doi.org/10.1007/s00464-011-1686-1

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