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The performance of transoral therapy is limited by the need to achieve triangulation
for tissue exposure, dissection, and instrumentation and by the small channel size
of an endoscope. A novel transgastric trocar (EndoTAGSS, Kansas City, Kansas, USA)
is explained in this video (Video 1, available online at www.giejournal.org) and is used in a porcine model with a proven endoscopic technique analogous to percutaneous
endoscopic gastrostomy (PEG) tube placement. The device allows for triangulation and
novel intralumenal techniques in a dual endoscopic/laparoscopic operating field governed
by the gastroenterologist. This video summarizes device placement, applications, and
tract closure for this novel system. Placement of the intragastric trocar under endoscopic
visualization is similar to a pull-PEG (Fig. 1). Once in place, the tapered headpiece is exchanged for a self-sealing introducer
cap, and laparoscopic tools may be inserted through the device into the stomach. The
techniques of endoscopic submucosal dissection using forceps traction, stapling at
the gastroesophageal junction, and using full-thickness resection with a laparoscopic
stapler are shown. Closure of the trocar tract with 2 full-thickness sutures using
the device’s built-in needle guides is demonstrated. Animal studies were approved
by the Pine Acres Rabbitry Farm Institutional Animal Care and Use Committee (IACUC)
and followed the American Physiological Society guidelines for the care and use of
animals. This novel percutaneous intragastric trocar enables improved tissue manipulation
and endolumenal use of laparoscopic devices. The system is placed by use of a safe
and familiar technique, and it may simplify technically demanding endoscopic procedures.
Figure 1The percutaneous intragastric trocar alongside a standard 20F PEG tube.
