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Erschienen in: Surgical Endoscopy 9/2016

10.12.2015

Single-incision flexible endoscopy (SIFE) for detection and staging of peritoneal carcinomatosis

verfasst von: Haythem Najah, Réa Lo Dico, Marion Grienay, Anthony Dohan, Xavier Dray, Marc Pocard

Erschienen in: Surgical Endoscopy | Ausgabe 9/2016

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Abstract

Objective

To show the feasibility and the safety of peritoneal carcinomatosis (PC) evaluation by single-incision flexible endoscopy (SIFE) and to compare it to single-incision rigid endoscopy (SIRE).

Background

Direct peritoneal visualization, either by laparotomy or laparoscopy, continues to be the gold standard in diagnosing PC. We reported, in animal study, that combining single-incision laparoscopic surgery and flexible endoscopy improved evaluation of the peritoneal cavity in a live porcine model and in four human cadavers.

Methods

Patients, undergoing surgical exploration for diagnosis and staging of PC, were included in a prospective study. Using a superiority design a sample size of 47 patients was determined. Through a single incision, a standardized peritoneoscopy was conducted with rigid (SIRE) and with flexible endoscope (SIFE). Primary outcome was the access success rates for the 13 regions of the Peritoneal Carcinomatosis Index (PCI).

Results

Overall access to the 13 regions of PCI was successful in 83 % of the cases with SIRE and in 91.1 % with SIFE (p < 10−10). SIFE access rates were superior to SIREs’ in the regions: R1 (87.2 vs. 61.7 %, p = 0.002), R2 (87.2 vs. 66 %, p = 0.004), R3 (85.1 vs. 59.6 %, p = 0.001) and R6 (80.9 vs. 61.7 %, p = 0.008). The mean PCI was higher (p < 104) with SIFE 12.77 (±11.97) than with SIRE 11.77 (±11.63).

Conclusion

This prospective, comparative study shows that SIFE was significantly superior to SIRE in the exploration of some difficult-to-access peritoneal areas, located in regions 1, 2, 3 and 6. These two minimally invasive staging procedures are safe, feasible and have to be seen as complementary rather than competing.
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Metadaten
Titel
Single-incision flexible endoscopy (SIFE) for detection and staging of peritoneal carcinomatosis
verfasst von
Haythem Najah
Réa Lo Dico
Marion Grienay
Anthony Dohan
Xavier Dray
Marc Pocard
Publikationsdatum
10.12.2015
Verlag
Springer US
Erschienen in
Surgical Endoscopy / Ausgabe 9/2016
Print ISSN: 0930-2794
Elektronische ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-015-4682-z

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