Endoscopic Transgastric Abdominal Exploration and Organ Resection: Initial Experience in a Porcine Model
Section snippets
Animals
Female Yorkshire pigs (Parson’s Farm, Hadley, MA) weighing 25–30 kg were used for the study and were housed at Animal Research at Children’s Hospital, Boston, Massachusetts. The study protocol was approved by the animal research committee at Children’s Hospital.
Endoscopes and Instruments
Single- and double-channel gastroduodenoscopes (GIF Q140 and GIF 2T100; Olympus, Tokyo, Japan) were used. Endoscopes were chemically sterilized with 2.4% glutaraldehyde (Cidex; Johnson and Johnson, Irvine, CA) and air-dried. Reusable
Peritoneal Exploration
The abdomen and pelvis were successfully explored in all 9 animals. Initial experiments for developing the transgastric technique included 1 cadaver and 5 live, anesthetized animals that were killed immediately after surgery. Subsequent survival surgeries were performed in 3 pigs. It was found that the proximal anterior gastric wall provided the most reliable access to the peritoneal cavity with greatest ease. During endoscopic exploration, the stomach, liver, small bowel, colon, urinary
Discussion
Standard approaches for abdominal surgery include open laparotomy and laparoscopic procedures, both of which require incisions in the abdominal wall. Advances in minimally invasive surgery aim to decrease surgical morbidity and mortality and to improve surgical efficiency by using less invasive techniques. Minilaparotomy, minilaparoscopy, and combined laparoscopic procedures are now commonly performed for appendectomy, cholecystectomy, hysterectomy, salpingectomy, and tubal ligations.2, 3
Summary/Conclusion
The transgastric endoscopic route has been suggested as a novel technique for minimally invasive surgery of the abdomen and pelvis. Our study demonstrates that the peritoneal cavity can be systematically explored by using this approach with successful identification of most organs, and that organ resection (oophorectomy and partial hysterectomy) can be performed without early complications. Development of more dexterous endoscopic tools is crucial to the advancement of such endoscopic surgical
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Supported by the Division of Gastroenterology funds, Brigham and Women’s Hospital.
M. S. Wagh and B. F. Merrifield contributed equally to this work.