TY - JOUR
T1 - Endoscopic peritoneal access and insufflation
T2 - natural orifice transluminal endoscopic surgery
AU - Nau, Peter
AU - Anderson, Joel
AU - Needleman, Bradley
AU - Ellison, E. Christopher
AU - Melvin, W. Scott
AU - Hazey, Jeffrey W.
N1 - Funding Information:
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.
Copyright:
Copyright 2010 Elsevier B.V., All rights reserved.
PY - 2010/3
Y1 - 2010/3
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=77249114646&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=77249114646&partnerID=8YFLogxK
U2 - 10.1016/j.gie.2009.09.032
DO - 10.1016/j.gie.2009.09.032
M3 - Article
C2 - 20003968
AN - SCOPUS:77249114646
SN - 0016-5107
VL - 71
SP - 485
EP - 489
JO - Gastrointestinal endoscopy
JF - Gastrointestinal endoscopy
IS - 3
ER -