Endoscopic peritoneal access and insufflation: natural orifice transluminal endoscopic surgery

Nau, Peter; Anderson, Joel; Needleman, Bradley; Ellison, E. Christopher; Melvin, W. Scott; Hazey, Jeffrey W.

doi:10.1016/j.gie.2009.09.032

« Previous Next »Gastrointestinal Endoscopy
Volume 71, Issue 3 , Pages 485-489, March 2010

Endoscopic peritoneal access and insufflation: natural orifice transluminal endoscopic surgery

Current affiliations: Division of General Surgery and the Center for Minimally Invasive Surgery (P.N., J.A., B.N., W.S.M., J.W.H.), Department of Surgery (E.C.E.), The Ohio State University School of Medicine and Public Health, Columbus, Ohio, USA

Received 29 June 2009; accepted 25 September 2009. published online 09 December 2009.

Columbus, Ohio, USA

Background

Diagnostic transgastric endoscopic peritoneoscopy is a safe model for exploration of the peritoneum. Endoscopic insufflation of the peritoneal cavity has not been validated in humans. We report here our experience with pneumoperitoneum established endoscopically with a laparoscopic insufflator.

Design

Pneumoperitoneum was established with a laparoscopic insufflator through the biopsy channel of the gastroscope. Intra-abdominal pressure was measured with a transfascial Veress needle and compared with endoscopic values. The gastrotomy was used in the creation of the gastric pouch.

Patients

Twenty patients undergoing laparoscopic Roux-en-Y gastric bypass participated in the study. Ten had undergone no previous surgery, whereas the other 10 patients had a history of abdominal procedures.

Interventions

Diagnostic transgastric endoscopic peritoneoscopy was performed through a gastrotomy created endoscopically without laparoscopic visualization.

Main Outcome Measurements

Diagnostic findings, operating times, and clinical course were recorded.

Results

The average time for transgastric access was 9.6 minutes. This did not vary in patients with previous surgery (P = .3). Endoscopic insufflation was successful in all patients. The mean endoscopic and laparoscopic pressures were 9.80 and 9.75 mm Hg, respectively (P = .9). In no patients were there limitations to visualization of the abdomen. Adhesions were noted in 80% and 10% of patients with and without a history of surgery, respectively (P = .005). There were no complications related to transgastric passage of the endoscope or exploration of the peritoneal cavity.

Conclusions

Although limited by the small sample size in this study, we believe that transgastric access may be considered as an alternative approach to peritoneal insufflation and provides a safe alternative for exploration of the abdomen. Endoscopic insufflation through the biopsy channel by using a laparoscopic insufflator seems to be an effective and safe method for establishing pneumoperitoneum.

Abbreviations: DTEP, diagnostic transgastric endoscopic peritoneoscopy, NOTES, natural orifice transluminal endoscopic surgery

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DISCLOSURE: This project was supported by a Stryker research grant, the 2008 Olympus Medical Systems NOSCAR Research Award, a Boston Scientific training grant. The following authors disclosed financial relationships relevant to this publication: P.N. Nau: Training grant from Covidien. B. Needleman: Research grant from Covidien. W.S. Melvin: Training grant from Covidien; member of the advisory board of and training grant from Stryker; member of the advisory board of Endogastric Solutions; member of the advisory board of Surgiquest. J.W. Hazey: Member of the clinical advisory board of Covidien; member of the clinical advisory board of Ethicon; training grant from Boston Scientific; research grant from Stryker. The other authors disclosed no financial relationships relevant to this publication.