Assistance Publique-Hôpitaux de Paris (APHP), Department of Digestive Diseases, Tertiary Care Centre for Peritoneal Carcinomatosis, Lariboisière Hospital, School of Surgery, Paris, France.
Surg Endosc. 2012 Sep;26(9):2658-66. doi: 10.1007/s00464-012-2251-2. Epub 2012 Apr 5.
Preoperative radiological diagnosis and evaluation of limited peritoneal carcinomatosis (PC) is suboptimal. Triangle laparoscopy is considered a noncarcinologic option due to the risk of tumoral spreading through the lateral ports into the abdominal wall muscles. Open surgery is therefore often needed to characterize PC. A minimally invasive approach would be progress.
We aimed to compare access rates to elective sites of PC using natural orifice transluminal endoscopic surgery (NOTES) with those using single-port laparoscopic surgery (SPLS). Sixteen acute experiments were performed in a live porcine model. Back-to-back NOTES and SPLS standardized peritoneoscopy were conducted in a cross-over design. Access rates to 11 elective sites of PC were considered as end points based on operators' consensus and necropsy verification.
Access to the targets was successful in 89 % with NOTES and 80 % with SPLS (p = 0.27). NOTES and SPLS achieved a 100 % access rate to the diaphragmatic domes and paracolic gutters, to the splenic area, to the pelvic floor, and to the trigonal bladder (p > 0.99). Access rates of NOTES versus SPLS to other elective sites of PC were the following: mesentery root (94 % vs. 0 %, p < 0.001), inferior mesenteric vein origin (88 % vs. 0 %, p < 0.001), inferior vena cava (88 % vs. 75 %, p = 0.85), and hepatic pedicle (8 % vs. 100 %, p < 0.001).
Both transgastric NOTES and SPLS provided quick and easy access to most elective sites of PC, except for the mesenteric vessel root (better achieved by NOTES) and the hepatic pedicle (better achieved by SPLS). Both techniques could be improved or combined to overcome their specific drawbacks.
局限性腹膜癌病（PC）的术前放射学诊断和评估并不理想。由于肿瘤通过侧端口扩散到腹壁肌肉的风险，三角腹腔镜被认为是非肿瘤学的选择。因此，通常需要开放手术来确定 PC 的特征。微创方法将是一种进步。
我们旨在比较使用自然腔道内镜手术（NOTES）和单孔腹腔镜手术（SPLS）进入 PC 择期部位的通道率。在活体猪模型中进行了 16 项急性实验。在交叉设计中进行了背对背 NOTES 和 SPLS 标准化腹膜检查。根据操作人员的共识和尸检验证，将 11 个 PC 择期部位的通道率作为终点。
NOTES 进入目标的成功率为 89%，SPLS 为 80%（p=0.27）。NOTES 和 SPLS 100%进入膈肌穹顶和结肠旁沟、脾区、骨盆底和三角膀胱（p>0.99）。NOTES 与 SPLS 进入其他 PC 择期部位的通道率如下：肠系膜根部（94%对 0%，p<0.001）、肠系膜下静脉起源（88%对 0%，p<0.001）、下腔静脉（88%对 75%，p=0.85）和肝蒂（8%对 100%，p<0.001）。
经胃 NOTES 和 SPLS 均可快速、轻松地进入大多数 PC 择期部位，除肠系膜血管根部（NOTES 效果更好）和肝蒂（SPLS 效果更好）外。这两种技术都可以改进或结合，以克服其特定的缺点。
