McGee M F, Rosen M J, Marks J, Chak A, Onders R, Faulx A, Ignagni A, Schomisch S, Ponsky J
Department of Surgery, Case Western Reserve University, Case Medical Center, 11100 Euclid Avenue, Cleveland, OH 44106, USA.
Surg Endosc. 2007 Apr;21(4):672-6. doi: 10.1007/s00464-006-9124-5. Epub 2007 Feb 7.
Natural orifice translumenal endoscopic surgery (NOTES) provides surgical access to the peritoneal cavity without skin incisions. The NOTES procedure requires pneumoperitoneum for visualization and manipulation of abdominal organs, similar to laparoscopy. Accurate measurement of the pneumoperitoneum pressure is essential to avoid potentially deleterious effects of intraabdominal compartment syndrome. A reliable method for monitoring pneumoperitoneum pressures during NOTES has not been identified. This study evaluated several methods of monitoring intraabdominal pressures with a standard gastroscope during NOTES.
Four female pigs (25 kg) were sedated, and a single-channel gastroscope was passed transgastrically into the peritoneal cavity. Pneumoperitoneum was achieved via a pressure insufflator through a percutaneous, intraperitoneal 14-gauge catheter. Three other pressures were recorded via separate catheters. First, a 14-gauge percutaneous catheter passed intraperitoneally measured true intraabdominal pressure. Second, a 14-gauge tube attached to the endoscope was used to measure endoscope tip pressure. The third pressure transducer was connected directly to the accessory channel of the endoscope. The abdomen was insufflated to a range of pressures (10-30 mmHg), and simultaneous pressures were recorded from all three pressure sensors.
Pressure correlation curves were developed for all animals across all intraperitoneal pressures (mean error, -4.25 to -1 mmHg). Endoscope tip pressures correlated with biopsy channel pressures (R2 = 0.99). Biopsy channel and endoscope tip pressures fit a least-squares linear model to predict actual intraabdominal pressure (R = 0.99 for both). Both scope tip and biopsy channel port pressures were strongly correlative with true intraabdominal pressures (R2 = 0.98 and R2 = 0.99, respectively).
This study demonstrates that monitoring pressure through an endoscope is reliable and predictive of true intraabdominal pressure. Gastroscope pressure monitoring is a useful adjunct to NOTES. Future NOTES procedures should incorporate continuous intraabdominal pressure monitoring to avoid the potentially deleterious effects of pneumoperitoneum during NOTES. This can be achieved by the integration of pressure-monitoring capabilities into gastroscopes.
经自然腔道内镜手术（NOTES）可在不做皮肤切口的情况下进入腹腔进行手术。NOTES手术与腹腔镜手术类似，需要气腹来观察和操作腹腔器官。准确测量气腹压力对于避免腹腔间隔室综合征的潜在有害影响至关重要。目前尚未确定一种可靠的NOTES手术期间气腹压力监测方法。本研究评估了在NOTES手术期间使用标准胃镜监测腹腔内压力的几种方法。
对4只雌性猪（25千克）进行镇静，通过经胃途径将单通道胃镜插入腹腔。通过压力注入器经皮经腹腔14号导管建立气腹。通过单独的导管记录其他三个压力。首先，经皮经腹腔插入的14号导管测量真实的腹腔内压力。其次，连接到内镜的14号管用于测量内镜尖端压力。第三个压力传感器直接连接到内镜的附件通道。将腹部充气至一系列压力（10 - 30 mmHg），并同时记录来自所有三个压力传感器的压力。
为所有动物在所有腹腔内压力下绘制了压力相关曲线（平均误差，-4.25至-1 mmHg）。内镜尖端压力与活检通道压力相关（R2 = 0.99）。活检通道和内镜尖端压力符合最小二乘线性模型以预测实际腹腔内压力（两者R = 0.99）。内镜尖端和活检通道端口压力均与真实腹腔内压力密切相关（分别为R2 = 0.98和R2 = 0.99）。
本研究表明，通过内镜监测压力是可靠的，并且可以预测真实的腹腔内压力。胃镜压力监测是NOTES手术的有用辅助手段。未来的NOTES手术应纳入连续的腹腔内压力监测，以避免NOTES手术期间气腹的潜在有害影响。这可以通过将压力监测功能集成到胃镜中来实现。
