Abstract
Background
The self-approximating translumenal access technique (STAT) has been shown to provide a safe and reliable means of abdominal access for natural orifice translumenal endoscopic surgery (NOTES). However, the feasibility of using STAT for translumenal organ resection is unknown. This study aimed to evaluate the technical performance of organ resection using STAT, the integrity of the STAT gastric tunnel after organ resection, and the postoperative morbidity of organ resection using STAT.
Methods
In this study, 14 domestic swine underwent transgastric organ resection (7 cholecystectomies, 7 uterine horn resections) followed by sequential removal of two different sizes of standardized specimens. Evaluation of operative injury to the tunnel and difficulty of specimen extraction was performed. After 2 weeks of observation, necropsy was performed for evaluation and documentation of gross findings.
Results
The mean operating room time (intubation recovery) was 4.1 h. A tunnel with a mean length of 12 cm and a mean width of 4 cm was created. The tunnel remained fully intact in 14 of 14 animals after organ resection, in 13 of 13 animals after balloon extraction, and in 12 of 14 animals after rigid specimen extraction (1 clinically significant tear occurred). Postoperatively, all the animals gained weight appropriately. Necropsy findings included adhesions (n = 4), bile leak (n = 2), minor lap-port abscess (n = 1), and ventral hernia (n = 1).
Conclusions
Although this study was a limited, prospective, animal survival study without a control arm, it again indicates that STAT allows safe abdominal access, a reliable means of closure, and directed endoscope positioning. Although one significant mucosal tear did occur, this study suggests STAT will tolerate the mechanical forces of peroral transgastric procedures provided the organ resected is small to moderate in size (<8 × 3 cm).
Similar content being viewed by others
References
Hawes RH, Kalloo A, Rattner D, Brugge W, Gostout C, Kantsevo S, Morhn M, Pasricha J, Ponsky J, Swanstrom L, Rothstein R, Thompson C (2006) ASGE/SAGES working group on natural orifice translumenal endoscopic surgery. Gastrointest Endosc 63:199–203
Ponsky JL (2005) Gastroenterologists as surgeons: what they need to know. Gastrointest Endosc 61:454
Reddy DN, Rao GV (2007) Transgastric approach to the peritoneal cavity: are we on the right track? Gastrointest Endosc 65:501–502
Sclabas GM, Swain P, Swanstrom LL (2006) Endolumenal methods for gastrotomy closure in natural orifice transenteric surgery (NOTES). Surg Innov 13:23–30
Ryou M, Pai R, Sauer J, Rattner D, Thompson C (2007) Evaluating an optimal gastric closure method for transgastric surgery. Surg Endosc 21:677–680
Merrifield BF, Wagh MS, Thompson CC (2006) Peroral transgastric organ resection: a feasibility study in pigs. Gastrointest Endosc 63:693–697
Pai RD, Fong DG, Bundga ME, Odze RD, Rattner DW, Thompson CC (2006) Transcolonic endoscopic cholecystectomy: a NOTES survival study in a porcine model. Gastrointest Endosc 64:428–434
McGee MF, Marks JM, Onders RP, Chak A, Rosen MJ, Jin J, Ponsky JL (2008) Infectious implications in the porcine model of natural orifice transluminal endoscopic surgery (NOTES) with PEG-tube closure: a quantitative bacteriologic study. Gastrointest Endosc 68:310–314
Moyer MT, Pauli EM, Haluck RS, Mathew A (2007) The self-approximating translumenal access technique (STAT) for potential use in NOTES: an ex vivo porcine model (with video). Gastrointest Endosc 66:974–978
Pauli EM, Moyer MT, Haluck RS, Mathew A (2008) Self-approximating translumenal access technique (STAT) for NOTES: a porcine survival study (with video). Gastrointest Endosc 67:690–697
Pauli EM, Haluck RS, Ionescu AM, Rogers AM, Shope TR, Moyer MT, Biswas A, Mathew A (2010) Directed submucosal tunneling permits in-line endoscope positioning for transgastric NOTES (with video). Surg Endosc 24(6):1474–1481
von Delius S, Gillen S, Doundoulakis E, Schneider A, Wilhelm D, Fiolka A, Schmid RM, Feussner H, Meining A (2008) Comparison of transgastric access techniques for natural orifice transluminal endoscopic surgery. Gastrointest Endosc 68:940–946
Sumiyama K, Gostout CJ, Rajan E, Bakken TA, Deters JL, Knipschield MA, Hawes RH, Kalloo AN, Pasricha PJ, Chung S, Cotton PB (2006) Pilot study of the porcine uterine horn as an in vivo appendicitis model for development of endoscopic transgastric appendectomy. Gastrointest Endosc 64:808–812
Wagh MS, Merrifield BF, Thompson CC (2005) Endoscopic transgastric abdominal exploration and organ resection: initial experience in a porcine model. Clin Gastroenterol Hepatol 3:892–896
Wagh MS, Merrifield BF, Thoompson CC (2006) Survival studies after endoscopic transgastric oophorectomy and tubectomy in a porcine model. Gastrointest Endosc 63:473–478
Park PO, Bergstrom M, Ikeda K, Ravens AF, Swain P (2005) Experimental studies of transgastric gallbladder surgery: cholecystectomy and cholecystogastric anastomosis. Gastrointest Endosc 61:601–606
Rolanda C, Lima E, Pego JM, Coelho TH, Silva D, Moreira I, Macedo G, Carvalho JL, Pinto JC (2007) Third-generation cholecystectomy by natural orifices: transgastric and transvesicular combined approach (with video). Gastrointest Endosc 65:111–117
Shih SP, Kantsevoy SV, Kalloo AN, Magno P, Giday SA, Ko CW, Isakovich NV, Meireles O, Hanly EJ, Marohn MR (2007) Hybrid minimally invasive surgery: a bridge between laparoscopic and translumenal surgery. Surg Endosc 21:1450–1453
AVMA Panel on Euthansia (2001) Report of the AVMA Panel on Euthansia. J Am Vet Assn 218:669–701
Sumiyama K, Gostout CJ, Rajan E, Bakken TA, Knipschield MA, Marler RJ (2007) Submucosal endoscopy with mucosal flap safety valve. Gastrointest Endosc 65:688–694
Sumiyama K, Gostout CJ, Rajan E, Bakken TA, Knipschield MA, Chung S, Cotton PB, Hawes RH, Kalloo AN, Kantsevoy SV, Pasricha PJ (2007) Transgastric cholecystectomy: transgastric accessibility to the gallbladder improved with the SEMF method and a novel multibending therapeutic endoscope. Gastrointest Endosc 65:1028–1034
Acknowledgment
The authors acknowledge that this project was funded through the generous support of the 2008 NOSCAR-Covidien Research Fund and is in accordance with the guidelines for NOTES research as outlined by SAGES and ASGE, and their support is appreciated.
Disclosures
The Penn State NOTES Working Group has received unrestricted donations of endoscopic equipment and supplies from Olympus Optical Co. and Boston Scientific Inc. At no time were these entities or one of their representatives privy to the results of this investigation or the interpretation of its findings. Matthew T. Moyer, Eric M. Pauli, Jegan Gopal, Abraham Mathew, and Randy S. Haluck no financial relationships with a commercial entity producing health-care related products and/or services relevant to this article.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Moyer, M.T., Pauli, E.M., Gopal, J. et al. Durability of the self-approximating translumenal access technique (STAT) for potential use in natural orifice translumenal surgery (NOTES). Surg Endosc 25, 315–322 (2011). https://doi.org/10.1007/s00464-010-1141-8
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-010-1141-8