Original articleExperimental endoscopyOmentoplasty for gastrotomy closure after natural orifice transluminal endoscopic surgery procedures (with video)
Section snippets
Methods
This study was approved by the Johns Hopkins University School of Medicine Animal Care Institutional Review Board. We performed 9 survival experiments on 40-kg female pigs (Sus scrofus domesticus). All pigs were fed daily with 6 cans of Ensure (16 ounces, Abbott Laboratories, North Chicago, Ill) for 2 days before endoscopy and then were fasted overnight with unrestricted access to water. All procedures were performed with the animal under 1.5% to 2% isoflurane general anesthesia with 6.5-mm
Results
All 9 survival experiments were successfully completed (Table 1). Transgastric access to the peritoneal cavity was achieved in all pigs. In 2 pigs (33%) with an EFTR opening, a 1.3 cm2 full-thickness piece of gastric wall was successfully removed (Fig. 1), which permitted easy access to the peritoneal cavity. In the 4 remaining pigs of this series (67%), the gastric wall resection was found to be incomplete (submucosal resection). In these cases, the gastrotomy was enlarged by needle-knife
Discussion
The greater omentum has antibacterial, hemostatic, angiogenic, and adhesive properties that could be a major asset in wound healing and prevention of postprocedure leakage.25 The cellular immune system (dendritic cells, macrophages, mast cells)28, 29 and regulatory cytokines produced by mesothelial cells30, 31 are present in the omentum and play a key role in the control of peritoneal infection. A high concentration of hemostatic tissue factor (promoting the coagulation process) and mesothelial
References (60)
- et al.
Flexible transgastric peritoneoscopy: a novel approach to diagnostic and therapeutic interventions in the peritoneal cavity
Gastrointest Endosc
(2004) Gastroenterologists as surgeons: what they need to know
Gastrointest Endosc
(2005)- et al.
Transgastric surgery in the abdomen: the dawn of a new era?
Gastrointest Endosc
(2005) - et al.
Peroral transgastric endoscopic ligation of fallopian tubes with long-term survival in a porcine model
Gastrointest Endosc
(2005) - et al.
Endoscopic gastrojejunostomy with survival in a porcine model
Gastrointest Endosc
(2005) - et al.
A novel safe approach to the peritoneal cavity for per-oral transgastric endoscopic procedures
Gastrointest Endosc
(2007) - et al.
Transvesical endoscopic peritoneoscopy: a novel 5 mm port for intra-abdominal scarless surgery
J Urol
(2006) - et al.
Transcolonic endoscopic cholecystectomy: a NOTES survival study in a porcine model (with video)
Gastrointest Endosc
(2006) - et al.
Experimental studies of transgastric gallbladder surgery: cholecystectomy and cholecystogastric anastomosis (videos)
Gastrointest Endosc
(2005) - et al.
Endoscopic transgastric abdominal exploration and organ resection: initial experience in a porcine model
Clin Gastroenterol Hepatol
(2005)
Endoscopic full-thickness resection: new minimally invasive therapeutic alternative for GI-tract lesions
Gastrointest Endosc
Transgastric approach to the peritoneal cavity: are we on the right track?
Gastrointest Endosc
A justification for NOTES natural orifice transluminal endosurgery
Gastrointest Endosc
Transgastric anastomosis by using flexible endoscopy in a porcine model (with video)
Gastrointest Endosc
Endoscopic transgastric lymphadenectomy by using EUS for selection and guidance
Gastrointest Endosc
Transgastric gastropexy and hiatal hernia repair for GERD under EUS control: a porcine model
Gastrointest Endosc
Eagle Claw II: A novel endosuture device that uses a curved needle for major arterial bleeding: a bench study
Gastrointest Endosc
Submucosal endoscopy with mucosal flap safety valve
Gastrointest Endosc
The greater omentum: anatomy, embryology, and surgical applications
Surg Clin North Am
Improvement of interobserver reproducibility of adhesion scoring systems
Fertil Steril
Stimulation of mesothelial cell proliferation by exudate macrophages enhances serosal wound healing in a murine model
Am J Pathol
Human peritoneal mesothelial cells produce many cytokines (granulocyte colony-stimulating factor [CSF], granulocyte-monocyte-CSF, macrophage-CSF, interleukin-1 [IL-1], and IL-6) and are activated and stimulated to grow by IL-1
Blood
The peritoneal cavity is a distinct compartment of angiogenic molecular mediators
J Surg Res
Angiogenic factor: a possible mechanism for neovascularization produced by omental pedicles
J Thorac Cardiovasc Surg
Use of pedicled omentum in esophagogastric anastomosis for prevention of anastomotic leak
Ann Thorac Surg
Omental protection of intestinal anastomoses
Am J Surg
A case of perforating gastric ulcer in which the opening being otherwise intractable was closed by means of an omental plug: recovery
Lancet
Combined laparoscopic-endoscopic method using an omental plug for therapy of gastroduodenal ulcer perforation
Gastrointest Endosc
Feasibility of endoscopic transgastric distal pancreatectomy in a porcine animal model
Gastrointest Endosc
Survival studies after endoscopic transgastric oophorectomy and tubectomy in a porcine model
Gastrointest Endosc
Cited by (26)
Clips for closure of full-thickness defects
2015, Techniques in Gastrointestinal EndoscopyCitation Excerpt :Other variations (described in animal models of NOTES) preapply the loop (or loops) with TTS clips to the mucosa before the transmural incision [21,22]. Following the example of the omental patch (also known as Graham patch) for surgical treatment of perforated peptic ulcers, endoscopists have described drawing the omentum into a full-thickness defect to assist in closure, especially when the defect is too large to close completely with clips alone [23,24,42]. This has been variously termed omental patching, omentoplasty, omentopexy, and omental plugging.
Comparison of gastrotomy closure modalities for natural orifice transluminal surgery: A canine study
2013, Gastrointestinal EndoscopyCitation Excerpt :A larger prospective randomized trial later confirmed the safety and reliability of OP for large-sized gastroduodenal perforation repair.28 In 2009, a porcine study reported the technical feasibility of using OP for NOTES gastric closure.30 However, the value of this novel closure approach remains unclear because only the negative control of gastrotomy by endoscopic full-thickness resection without closure was used in this pilot exploratory study.
Endoscopic closure devices
2012, Gastrointestinal EndoscopyEndoscopic closure of GI fistulae by using an over-the-scope clip (with videos)
2010, Gastrointestinal EndoscopyCitation Excerpt :With the advent of natural orifice transluminal endoscopic surgery, development of a reliable, safe, and reproducible endoscopic closure became a prerequisite for this novel endosurgical approach. Consequently, in recent years, numerous devices have been developed to stitch, staple, or clip GI wall defects from an endoluminal approach.1,4,6,8,12-20 One of these novel devices is the OTSC system, which has recently become commercially available in Europe and is in the regulatory process in the United States.
On the road to a purebred NOTES procedure
2010, Gastrointestinal Endoscopy
DISCLOSURE: The following authors disclosed financial relationships relevant to this publication: X. Dray was supported by the French National Society for Gastroenterology (Société Nationale Française de Gastroentérologie, Robert Tournut Scholarship, 2006) and the American Gastroenterological Association Foundation for Digestive Health and Nutrition (Jon I. Isenberg International Scholar Award, 2007) for his training and research in NOTES. S. V. Kantsevoy and A. N. Kalloo are equity holders in Apollo Endosurgery Inc, Austin, Texas. All other authors disclosed no financial relationships relevant to this publication.
If you want to chat with an author of this article, you may contact him at [email protected].