Department of Surgical Gastroenterology, Herlev Hospital, University of Copenhagen, Herlev Ringvej 75, 2730 Herlev, Denmark.
Surg Endosc. 2012 Jul;26(7):1952-62. doi: 10.1007/s00464-011-2135-x. Epub 2012 Jan 12.
Most natural orifice transluminal endoscopic surgery (NOTES) procedures to date rely on the hybrid technique with simultaneous laparoscopic access to protect against access-related complications and to achieve adequate triangulation for dissection. This is done at the cost of the potential benefits of this new minimally invasive technique. This study aimed to evaluate the feasibility and safety of a transgastric (TG) pure-NOTES procedure in a diagnostic setting.
A TG pure-NOTES procedure with endoscopic ultrasonograpy (EUS)-guided access and over-the-scope-clip (OTSC) closure was performed for 10 pigs in a survival and feasibility study. A full macroscopic necropsy with subsequent histologic evaluation was performed on postoperative day (POD) 14. The outcome parameters were uncomplicated follow-up assessment, survival, intraoperative complications, intraabdominal pathology, macroscopic full-thickness closure, and histology-proven full-thickness healing of the gastrotomy.
An uncomplicated postoperative course was reported for 9 of the 10 pigs, and survival was reported for all 10 pigs. For all the pigs, EUS-guided access was performed successfully with a median duration of 25 min (range, 12-62 min) and without intraoperative complications or access-related lesions at necropsy. An OTSC closure was achieved with a median duration of 11 min (range, 3-28 min). The OTSC provided immediate closure, but according to the authors' definition of a full-thickness healing evaluated by histologic examination, this was not achieved in any of the cases. Although all the animals survived until POD 14, intraabdominal chronic abscesses were present in 3 of the 10 pigs at necropsy.
The EUS-guided TG access proved to be feasible without access-related complications. Although OTSC provided an immediate closure, the histopathology raised concerns regarding the risk of perforation. Together with the high risk of intraabdominal infection, TG pure-NOTES is not yet ready for routine clinical practice.
迄今为止，大多数经自然腔道内镜外科（NOTES）手术都依赖于混合技术，同时进行腹腔镜进入以防止与进入相关的并发症，并实现足够的三角解剖。这样做的代价是这种新的微创技术的潜在好处。本研究旨在评估经胃（TG）纯NOTES 程序在诊断环境中的可行性和安全性。
在一项生存和可行性研究中，对 10 头猪进行了经内镜超声（EUS）引导的 TG 纯NOTES 手术和过镜夹（OTSC）闭合。术后第 14 天进行了全面的大体尸检和随后的组织学评估。主要观察参数为无并发症的随访评估、生存、术中并发症、腹腔内病理、大体全层闭合和经组织学证实的胃切开术全层愈合。
报告了 10 头猪中的 9 头有顺利的术后过程，所有 10 头猪均存活。所有猪均成功进行了 EUS 引导的进入，中位时间为 25 分钟（范围 12-62 分钟），无术中并发症或尸检时与进入相关的病变。中位时间为 11 分钟（范围 3-28 分钟）即可实现 OTSC 闭合。OTSC 立即闭合，但根据作者通过组织学检查评估的全层愈合的定义，没有一个病例达到。尽管所有动物都存活到术后第 14 天，但在 10 头猪中有 3 头在尸检时出现腹腔内慢性脓肿。
EUS 引导的 TG 进入证明是可行的，没有与进入相关的并发症。尽管 OTSC 提供了即时闭合，但组织病理学引起了对穿孔风险的关注。加上腹腔内感染的高风险，TG 纯NOTES 还没有准备好用于常规临床实践。
