Department of Surgery, University Hospitals Case Medical Center, 11100 Euclid Avenue, Cleveland, OH 44106, USA.
Surg Endosc. 2011 Dec;25(12):3906-11. doi: 10.1007/s00464-011-1818-7. Epub 2011 Jul 26.
The advancement of natural orifice translumenal endoscopic surgery (NOTES) into clinical practice is dependent on its safety, efficacy, and efficiency. Access is the obligatory first step in NOTES and serves as a surrogate to technical difficulties associated with this novel surgical approach. This study aimed to compare endoscopic transgastric access techniques in terms of safety, reproducibility, and efficiency.
Seven variations for anterior transgastric NOTES access were evaluated with female domestic swine. After marking of an anterior site, electrocautery was used to create a small gastrotomy, followed by balloon dilation and entry into the peritoneal cavity. Methodologic variations incorporated the use of guidewires, electrocautery and dilation combined within a single device, support tubes, and dilation without electrocautery. Access times were recorded, and tissue injury was evaluated.
In 70 access attempts, the most serious complication was bleeding from the gastroepiploic vessel, controlled with electrocautery. High variability in access times was prevalent with almost all the access techniques.
This study supports the presumption that an anterior transgastric access technique for NOTES procedures is safe. The use of a wire to mark the site and another wire to retain the gastrotomy provided safe, efficient, and reproducible transgastric access. Comparison with laparoscopy exposed the disparity in technical challenges facing NOTES, suggesting that new technology and further refinement in methodology are required for NOTES to be clinically relevant.
经自然腔道内镜外科（NOTES）进入临床实践取决于其安全性、有效性和效率。进入是NOTES 必不可少的第一步，是该新型手术方法相关技术难度的替代指标。本研究旨在比较经胃内镜入路技术在安全性、可重复性和效率方面的差异。
对 7 种经胃前入路 NOTES 进入技术进行了评估，实验对象为雌性家猪。在标记前部位后，用电灼法创建一个小胃造口，然后进行球囊扩张并进入腹腔。方法学的变化包括使用导丝、电切和扩张组合在一个单一的设备中、支撑管以及不使用电切的扩张。记录进入时间，并评估组织损伤。
在 70 次进入尝试中，最严重的并发症是胃网膜血管出血，用电灼法控制。几乎所有的进入技术都存在进入时间的高度变异性。
本研究支持经胃前入路 NOTES 手术技术安全的假设。使用导丝标记部位，另用导丝保留胃造口，可提供安全、有效和可重复的经胃进入。与腹腔镜检查的比较暴露了NOTES 面临的技术挑战的差异，表明需要新的技术和方法学的进一步改进，使 NOTES 具有临床相关性。
