Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA.
Surg Endosc. 2011 Oct;25(10):3191-7. doi: 10.1007/s00464-011-1686-1. Epub 2011 Apr 13.
Laparoscopic distal pancreatectomy is associated with high morbidity and mortality. NOTES tumor enucleation may provide an alternative to laparoscopic distal pancreatectomy. The goal of this study was to determine the feasibility of NOTES tumor creation and enucleation as a multidisciplinary approach.
A linear-array endoscopic ultrasound (EUS) endoscope was used to inject a thermosensitive ABA triblock polymer mixed with methylene blue through the stomach wall and into the distal pancreas using a 22-gauge EUS needle. Due to its thermosensitive character, the polymer solidifies in response to body temperature, creating an artificial tumor. Seventeen swine underwent NOTES transgastric pancreatic tumor enucleation. Nine nonsurvival animals were sacrificed immediately after the NOTES procedure, with subsequent necropsy. Eight survival animals were observed for up to 16 days after the procedure, subsequently sacrificed, followed by necropsy.
The procedure was performed successfully in all 17 pigs studied, 9/9 nonsurvival (100%) and 8/8 survival (100%) animals, using a pure NOTES approach without any laparoscopic ports. Complications included two esophageal dissections (1 in nonsurvival group, 1 in survival group) caused by the introduction of the endoscopic overtube (2/17, 12%), unrelated to the actual surgical procedure. In the survival animals, there were two small splenic lacerations caused during retraction with the endoscopic forceps, for which hemostasis was achieved prior to closure of the gastrotomy (2/7, 29%). At necropsy of the animals, there was sufficient closure of 15/17 gastrotomy sites (88%).
The creation of artificial pancreatic tumors via EUS guidance is feasible. Pancreatic tumor enucleation using a transgastric NOTES approach is technically feasible and could be an alternative to laparoscopic distal pancreatectomy with further development. Further adoption and adaptation of this technique will require the development of more sophisticated specialized tools to improve the safety profile of the procedure.
腹腔镜胰体尾切除术相关的发病率和死亡率较高。NOTES 肿瘤剜除术可能为腹腔镜胰体尾切除术提供替代方案。本研究旨在确定NOTES 肿瘤创建和剜除术作为多学科方法的可行性。
使用线性阵列内镜超声（EUS）内镜通过胃壁和使用 22G EUS 针将热敏 ABA 三嵌段聚合物与亚甲蓝混合注入远端胰腺。由于其热敏特性，聚合物在体温下凝固，形成人工肿瘤。17 头猪接受了经NOTES 经胃胰腺肿瘤剜除术。9 头非存活动物在 NOTES 手术后立即被处死，随后进行尸检。8 头存活动物在手术后观察长达 16 天，随后被处死，随后进行尸检。
所有 17 头研究猪均成功完成了该手术，9/9 例非存活（100%）和 8/8 例存活（100%）动物均成功完成了纯 NOTES 手术，未使用任何腹腔镜端口。并发症包括 2 例食管切开术（1 例非存活组，1 例存活组），由内镜外套管的引入引起（2/17，12%），与实际手术无关。在存活动物中，内镜钳在回缩过程中引起 2 个小的脾脏撕裂伤，在闭合胃切开术之前进行了止血（2/7，29%）。动物尸检时，有 15/17 个胃切开部位（88%）足够闭合。
通过 EUS 引导创建人工胰腺肿瘤是可行的。经胃NOTES 入路胰腺肿瘤剜除术在技术上是可行的，并且可以作为腹腔镜胰体尾切除术的替代方法，进一步发展。进一步采用和调整该技术需要开发更复杂的专门工具，以提高该手术的安全性。
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