Rolanda Carla, Lima Estêvão, Pêgo José M, Henriques-Coelho Tiago, Silva David, Moreira Ivone, Macedo Guilherme, Carvalho José L, Correia-Pinto Jorge
Life and Health Sciences Research Institute, School of Health Sciences, University of Minho, Braga, Portugal.
Gastrointest Endosc. 2007 Jan;65(1):111-7. doi: 10.1016/j.gie.2006.07.050.
An isolated transgastric port has some limitations in performing transluminal endoscopic cholecystectomy. However, transvesical access to the peritoneal cavity has recently been reported to be feasible and safe.
To assess the feasibility and the technical benefits of transgastric and transvesical combined approach to overcome the limitations of isolated transgastric ports.
We created a transgastric and transvesical combined approach to perform cholecystectomy in 7 consecutive anesthetized female pigs. The transgastric access was achieved after perforation and dilation of the gastric wall with a needle knife and with a balloon, respectively. Under cystoscopic control, an ureteral catheter, a guidewire, and a dilator of the ureteral sheath were used to place a transvesical 5-mm overtube into the peritoneal cavity. By using a gastroscope positioned transgastrically and a ureteroscope positioned transvesically, we carried out cholecystectomy in all animals.
Establishment of transvesical and transgastric accesses took place without complications. Under a carbon dioxide pneumoperitoneum controlled by the transvesical port, gallbladder identification, cystic duct, and artery exposure were easily achieved in all cases. Transvesical gallbladder grasping and manipulation proved to be particularly valuable to enhance gastroscope-guided dissection. With the exclusion of 2 cases where mild liver-surface hemorrhage and bile leak secondary to the sliding of cystic clips occurred, all remaining cholecystectomies were carried out without incidents.
Once closure of the gastric hole proved to be unreliable when using endoclips, the animals were euthanized; necropsy was performed immediately after the surgical procedure.
A transgastric and transvesical combined approach is feasible, and it was particularly useful to perform a cholecystectomy through exclusive natural orifices.
孤立的经胃入路在进行经腔内镜胆囊切除术中存在一些局限性。然而，最近有报道称经膀胱进入腹腔是可行且安全的。
评估经胃和经膀胱联合入路克服孤立经胃入路局限性的可行性和技术优势。
我们创建了一种经胃和经膀胱联合入路，对7只连续麻醉的雌性猪进行胆囊切除术。分别用针刀和球囊对胃壁进行穿孔和扩张后实现经胃入路。在膀胱镜控制下，使用输尿管导管、导丝和输尿管鞘扩张器将一根5毫米的经膀胱外套管置入腹腔。通过经胃放置的胃镜和经膀胱放置的输尿管镜，我们对所有动物实施了胆囊切除术。
经膀胱和经胃入路的建立均未出现并发症。在经膀胱端口控制的二氧化碳气腹下，所有病例均能轻松识别胆囊、暴露胆囊管和动脉。事实证明，经膀胱抓取和操作胆囊对于加强胃镜引导下的解剖尤为有价值。除2例因胆囊夹滑动导致轻度肝表面出血和胆漏外，其余所有胆囊切除术均顺利完成。
当使用内镜夹关闭胃孔被证明不可靠时，对动物实施安乐死；手术后立即进行尸检。
经胃和经膀胱联合入路是可行的，对于通过完全自然孔道进行胆囊切除术特别有用。
