Department of Surgery, Osaka University Graduate School of Medicine, 2-2, E-2, Yamadaoka, Suita, Osaka 565-0871, Japan.
Surg Endosc. 2013 Mar;27(3):1016-20. doi: 10.1007/s00464-012-2298-0. Epub 2012 Jun 21.
A modified percutaneous endoscopic gastrostomy (PEG) technique has been widely used as a safe alternative for gaining peritoneal access in transgastric (TG) natural orifice translumenal endoscopic surgery (NOTES). The authors developed a novel insufflating guidewire (IGW) system, which further maximizes the safety of the modified PEG technique by preparation of a preliminary pneumoperitoneum (PP) before TG route creation. This study aimed to assess the feasibility and safety of the modified PEG technique under PP using the IGW system.
The IGW system was evaluated in porcine models (n = 5). The process of PP creation was monitored with either laparoscopy or real-time magnetic resonance imaging. The times required to create PP and to establish the TG route were prospectively registered. The animals were killed at the end of each experiment for evaluation of any injuries to adjacent organs.
Preliminary pneumoperitoneum was successfully created in all the animals (median procedural time, 240 s) in rapid and highly reproducible fashion. The creation of the TG route also was quick and straightforward (median procedural time, 100 s). No injuries to the adjacent organs were noted at necropsy.
The establishment of the TG route under PP is feasible and safe with the authors' newly developed IGW system. The device seems to be advantageous because the entire session is endoscopically controlled. The device may become one of the useful alternatives for adopting TG NOTES in daily practice. Further assessment with human subjects is necessary to make this system practical and universal.
改良经皮内镜胃造口术（PEG）技术已广泛应用于经胃（TG）自然腔道内镜外科手术（NOTES）中作为获得腹膜入路的安全替代方法。作者开发了一种新型的充气导丝（IGW）系统，通过在 TG 入路创建前进行初步气腹（PP）准备，进一步提高了改良 PEG 技术的安全性。本研究旨在评估使用 IGW 系统在 PP 下改良 PEG 技术的可行性和安全性。
在猪模型中评估了 IGW 系统（n=5）。使用腹腔镜或实时磁共振成像监测 PP 建立过程。前瞻性记录建立 PP 和 TG 入路所需的时间。在每个实验结束时处死动物，以评估对邻近器官的任何损伤。
所有动物均成功快速且高度可重复地建立了初步气腹（中位手术时间 240s）。TG 入路的建立也快速而直接（中位手术时间 100s）。尸检时未发现邻近器官损伤。
使用作者新开发的 IGW 系统，在 PP 下建立 TG 入路是可行且安全的。该设备似乎具有优势，因为整个过程都是内镜控制的。该设备可能成为 TG NOTES 在日常实践中采用的有用替代方法之一。需要进一步对人体进行评估，以使该系统实用且通用。
