A self-approximating transluminal access technique for potential use in NOTES: an ex vivo porcine model (with video)

Background

NOTES (natural orifice transluminal endoscopic surgery) is an area of active research in experimental endoscopy and has the potential to significantly advance the field of minimally invasive surgery. Several investigators have illustrated the need for a transluminal access technique that is safe, reliable, and reproducible. Currently used methods directly cut through the organ wall into the peritoneum; however, rare difficulty in closing the defect with negative outcomes have been described.

Objective

To evaluate an alternative method for transluminal access.

Design

An ex vivo, experimental endoscopy study.

Setting

Penn State Hershey Medical Center, Animal Research Laboratories.

Methods

By using ex vivo porcine esophagus, stomach, and colon, a submucosal tunnel was created as a means of physically separating the lumen from the peritoneum during transluminal access. Postprocedure leak testing was performed, and all procedures were video recorded.

Results

Results of the self-approximating transluminal access technique (STAT) in porcine esophagus and stomach demonstrated the technical feasibility of this approach. The STAT was not felt to be feasible in the porcine colon.

Limitations

This investigation was a limited, ex vivo pilot study and will require further testing in an adequate number of live animals.

Conclusions

The STAT is technically feasible in porcine esophagus and stomach, and may have advantages over currently used techniques.

Abbreviations: ASGE, American Society for Gastrointestinal Endoscopy, GE, gastroesophageal, NOTES, natural orifice transluminal endoscopic surgery, SAGES, Society of American Gastrointestinal Endoscopic Surgeons, STAT, self-approximating transluminal access technique