Vanbiervliet Geoffroy, Gonzalez Jean-Michel, Bonin Eduardo Aimore, Garnier Emmanuelle, Giusiano Sophie, Saint Paul Marie-Christine, Berdah Stéphane, Barthet Marc
University of Nice Sophia-Antipolis, Nice, France University Hospital of Nice, Nice, France Laboratoire de Biomécanique Appliquée, UMRT24 IFSTTAR/Aix-Marseille University, France
Laboratoire de Biomécanique Appliquée, UMRT24 IFSTTAR/Aix-Marseille University, France Public Assistance Hospitals of Marseille, Marseille, France.
Surg Innov. 2014 Aug;21(4):409-18. doi: 10.1177/1553350613508016. Epub 2013 Nov 19.
Natural orifice transluminal endoscopic surgery (NOTES) could reduce procedure-associated morbidity and mortality. The aim of this study was to determine the feasibility of performing a simple model of gastrojejunal anastomosis in a living porcine model exclusively using NOTES.
It was a prospective experimental animal study concerning pigs weighing between 25 and 30 kg. Endoscopies were performed using a double-channel gastroscope. A preliminary phase allowed for the development of the technique on 3 animals that were immediately euthanized. The experimental phase included the implementation of a gastrojejunal anastomosis in 9 animals. Antibiotic therapy was continued for 7 days with gradual feeding. Surviving animals were euthanized after 3 weeks. Anastomosis permeability in each animal was confirmed by opacification, endoscopy, and histopathological analysis. The main outcome measurements were the feasibility and animal survival at 3 weeks postsurgery.
The entire procedure was performed on 9 animals (4 males and 5 females). Anastomosis required 4.7 ± 1.2 stitches (range 4-7). The average total length of the procedure was 143 ± 50.8 minutes (range 87-225 minutes). One bleeding, 2 suture dehiscences, and a poor stomach incision were the immediate complications endoscopically resolved. At 3 weeks, 5 animals had survived. Three animals died as a result of anastomotic leakage confirmed at necropsy and histopathology. In the surviving animals, histology confirmed permeable anastomoses with collagen scar tissue and continuity of the mucosa and mucosa muscle layers.
Successful gastrojejunal anastomosis by NOTES is technically feasible but is subject to a learning curve.
经自然腔道内镜手术（NOTES）可降低手术相关的发病率和死亡率。本研究的目的是确定在活体猪模型中仅使用NOTES进行简单胃空肠吻合术模型的可行性。
这是一项针对体重在25至30千克之间猪的前瞻性实验动物研究。使用双通道胃镜进行内镜检查。在3只立即实施安乐死的动物上进行了技术开发的初步阶段。实验阶段包括对9只动物实施胃空肠吻合术。抗生素治疗持续7天，并逐渐开始喂食。存活的动物在3周后实施安乐死。通过造影、内镜检查和组织病理学分析确认每只动物吻合口的通畅情况。主要观察指标为术后3周的可行性和动物存活率。
对9只动物（4只雄性和5只雌性）进行了整个手术过程。吻合需要4.7±1.2针（范围为4 - 7针）。手术的平均总时长为143±50.8分钟（范围为87 - 225分钟）。内镜下解决了1例出血、2例缝线裂开和1例胃切口不佳等即时并发症。3周时，5只动物存活。3只动物因尸检和组织病理学证实的吻合口漏而死亡。在存活的动物中，组织学证实吻合口通畅，有胶原瘢痕组织，黏膜和黏膜肌层连续。
NOTES成功进行胃空肠吻合术在技术上是可行的，但存在学习曲线。
