Division of General Surgery, The Ohio State University School of Medicine and Public Health, 410 West 10th Avenue, Columbus, OH 43210-1228, USA.
Surg Endosc. 2010 Jun;24(6):1440-6. doi: 10.1007/s00464-009-0797-4. Epub 2010 Jan 7.
The validity of natural orifice transluminal endoscopic surgery (NOTES) was confirmed in a human trial of 10 patients undergoing diagnostic transgastric endoscopic peritoneoscopy (DTEP) for staging of pancreatic head masses. This report is an update with 10 additional patients in the series and includes bacterial contamination data.
The patients in this human trial were scheduled to undergo diagnostic laparoscopy for abdominal staging of a pancreatic head mass. A second surgeon, blinded to the laparoscopic findings, performed a transgastric endoscopic peritoneoscopy (TEP). The findings of laparoscopic exploration were compared with that those of the TEP. Diagnostic findings, operative times, and clinical course were recorded. Bacterial contamination data were collected for the second cohort of 10 patients. Bacterial samples were collected from the scope before use and the abdominal cavity before and after creation of the gastrotomy. Samples were assessed for bacterial counts and species identification. Definitive care was rendered based on the findings from laparoscopy.
In this study, 20 patients underwent diagnostic laparoscopy followed by DTEP. The average time for completion of diagnostic laparoscopy was 10 min compared with 21 min for TEP. The experience acquired during the initial 10 procedures translated to a 7-min decrease in TEP time for the second 10 cases. For 19 of the 20 patients, DTEP corroborated laparoscopic findings for surgical decision making. One endoscopic and five laparoscopic biopsies were performed. Pancreaticoduodenectomy was performed for 14 patients and palliative gastrojejunostomy for 6 patients. No cross-contamination of the peritoneum or infectious complications were noted. No significant complications related to either the endoscopic or laparoscopic approach occurred.
This study supports the authors' previous conclusions that the transgastric approach to diagnostic peritoneoscopy is feasible, safe, and accurate. The lack of documented bacterial contamination further supports the use of this technique. Technical issues, including intraabdominal manipulation and gastric closure, require further investigation.
在一项针对 10 名接受经胃内镜腹膜检查术（DTEP）诊断性胰头肿块分期的患者的人体试验中，证实了经自然腔道内镜外科手术（NOTES）的有效性。本报告是该系列的更新，增加了 10 名患者，并包含细菌污染数据。
该人体试验的患者计划接受腹腔镜检查，以对胰头肿块进行腹部分期。第二位外科医生在不知道腹腔镜检查结果的情况下进行了经胃内镜腹膜检查（TEP）。比较腹腔镜探查的结果与 TEP 的结果。记录诊断结果、手术时间和临床过程。为第二批 10 名患者收集了细菌污染数据。在使用前和胃造口前后从内镜和腹腔采集细菌样本。评估细菌计数和物种鉴定。根据腹腔镜检查结果进行确定性治疗。
本研究中，20 名患者接受了诊断性腹腔镜检查，然后进行了 DTEP。完成诊断性腹腔镜检查的平均时间为 10 分钟，而 TEP 则为 21 分钟。在最初的 10 例中获得的经验使第二批 10 例的 TEP 时间缩短了 7 分钟。对于 20 名患者中的 19 名，DTEP 证实了腹腔镜检查结果，以便做出手术决策。进行了 19 例内镜和 5 例腹腔镜活检。对 14 名患者进行了胰十二指肠切除术，对 6 名患者进行了姑息性胃空肠吻合术。未发现腹膜污染或感染性并发症。内镜或腹腔镜方法均未发生明显并发症。
本研究支持作者之前的结论，即经胃入路诊断性腹膜镜检查是可行、安全和准确的。缺乏记录的细菌污染进一步支持了该技术的应用。需要进一步研究包括腹腔内操作和胃闭合在内的技术问题。
