von Delius S, Feussner H, Wilhelm D, Karagianni A, Henke J, Schmid R M, Meining A
2nd Medical Department, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany.
Endoscopy. 2007 May;39(5):407-11. doi: 10.1055/s-2007-966439.
Natural orifice transluminal endoscopic surgery (NOTES) is an emerging technology. Apart from its therapeutic implications, this type of access to the peritoneal cavity might also be useful for targeted in vivo histological investigation by means of confocal fluorescence microscopy. In this study we therefore aimed to assess the feasibility of miniprobe-based confocal fluorescence microscopy during transgastric endoscopy in an acute porcine model.
Transgastric in vivo histology was performed in five pigs, under general anesthesia. After incision of the anterior gastric wall, a double-channel video gastroscope was advanced into the peritoneal cavity. A flexible confocal miniprobe was introduced through the instrument channel of the endoscope after intravenous injection of 10 mL of fluorescein 1% in four of the pigs and of 50 mL of fluorescein isothiocyanate-dextran 150 000 4% in the fifth pig. The tip of the miniprobe was then placed on the peritoneal layer, the liver, and the spleen for confocal laser microscopy.
Probes were easily attached to the peritoneal layer, the liver, and the spleen under direct visualization with the endoscope. Dynamic microscopic images of these organs were obtained with a frame rate of 12 frames per second. The flow of erythrocytes through blood vessels could be seen. The microstructural components of organs, such as lobules of the liver, were also easily identified.
In vivo histology in the peritoneal cavity is feasible during NOTES and this technique combines the minimally invasive approach to the intraperitoneal organs afforded by NOTES and real-time, in vivo acquisition of dynamic histological images.
自然腔道内镜手术（NOTES）是一项新兴技术。除了其治疗意义外，这种进入腹腔的方式对于通过共聚焦荧光显微镜进行靶向体内组织学研究也可能有用。因此，在本研究中，我们旨在评估在急性猪模型经胃内镜检查期间基于微型探头的共聚焦荧光显微镜检查的可行性。
在全身麻醉下，对五头猪进行经胃体内组织学检查。切开胃前壁后，将双通道视频胃镜推进腹腔。在四头猪静脉注射10 mL 1%的荧光素，在第五头猪静脉注射50 mL 4%的异硫氰酸荧光素-葡聚糖150 000后，通过内镜的器械通道插入柔性共聚焦微型探头。然后将微型探头的尖端置于腹膜层、肝脏和脾脏上进行共聚焦激光显微镜检查。
在内镜直接观察下，探头很容易附着在腹膜层、肝脏和脾脏上。以每秒12帧的帧率获得了这些器官的动态微观图像。可以看到红细胞在血管中的流动。肝脏小叶等器官的微观结构成分也很容易识别。
在NOTES期间，腹腔内的体内组织学检查是可行的，该技术结合了NOTES对腹腔内器官的微创方法和实时、体内获取动态组织学图像。
