Feretis C, Kalantzopoulos D, Koulouris P, Kolettas C, Archontovasilis F, Chandakas S, Patsea H, Pantazopoulou A, Sideris M, Papalois A, Simopoulos K, Leandros E
Department of Therapeutic Endoscopy, Iaso General Hospital, Athens, Greece.
Endoscopy. 2007 May;39(5):394-400. doi: 10.1055/s-2007-966430.
An incisionless endoscopic peroral transgastric approach to the peritoneal cavity has shown promise in animals as a potentially less invasive form of surgery. We present our experience with various endoscopic peroral transgastric procedures, reporting on the technical aspects and challenges that arose.
The following procedures were performed in 10 anesthetized pigs using a double-channel endoscope: peritoneoscopy (10 pigs), liver biopsy (one pig), cholecystectomy (six pigs), fallopian tube excision (one pig), and hysterectomy (one pig).
All the procedures were accomplished successfully. There were six minor intraoperative complications. Complete gastric cleansing and elimination of all bacteria was found to be impossible to achieve in the porcine model. Overinflation was a common problem. The lack of adequate endoscope support was a major limitation. Safe closure of the gastrotomy incision was difficult using the available clipping devices. Six pigs made an uncomplicated recovery after a follow-up period of 4-6 weeks. Subsequent pathological examination revealed deep gastric ulceration in one animal and a gastric wall abscess in another.
Peroral transgastric surgery is technically feasible and safe in a porcine model. Although all the procedures were performed successfully, the study highlights some technical difficulties and illustrates the need for major technical innovations and extensive animal studies in order to evaluate the merits of incisionless surgery.
经口内镜下经胃进入腹腔的无切口手术方法在动物实验中已显示出作为一种潜在的侵入性较小的手术形式的前景。我们介绍了我们在各种经口内镜下经胃手术中的经验，报告了所出现的技术方面和挑战。
使用双通道内镜对10只麻醉的猪进行了以下手术：腹腔镜检查（10只猪）、肝活检（1只猪）、胆囊切除术（6只猪）、输卵管切除术（1只猪）和子宫切除术（1只猪）。
所有手术均成功完成。术中出现6例轻微并发症。在猪模型中发现完全清洁胃并消除所有细菌是不可能实现的。过度充气是一个常见问题。缺乏足够的内镜支撑是一个主要限制。使用现有的夹闭装置很难安全关闭胃切开切口。6只猪在4 - 6周的随访期后恢复顺利。随后的病理检查显示1只动物有深部胃溃疡，另1只动物有胃壁脓肿。
经口经胃手术在猪模型中技术上是可行且安全的。尽管所有手术均成功完成，但该研究突出了一些技术难题，并表明需要进行重大技术创新和广泛的动物研究，以评估无切口手术的优点。
