Authors: Jeffrey W Hazey Vimal K Narula David B Renton Kevin M Reavis Christopher M Paul Kristen E Hinshaw Peter Muscarella E Christopher Ellison W Scott Melvin
Publish Date: 2007/08/14
Volume: 22, Issue: 1, Pages: 16-20
Abstract
Naturalorifice translumenal endoscopic surgery NOTES is a possible advancement for surgical interventions We initiated a pilot study in humans to investigate feasibility and develop the techniques and technology necessary for NOTES Reported herein is the first human clinical trial of NOTES performing transoral transgastric diagnostic peritoneoscopyPatients were scheduled to undergo diagnostic laparoscopic evaluation of a pancreatic mass The findings of traditional laparoscopy were recorded by anatomical abdominal quadrant A second surgeon blinded to the laparoscopic findings performed transgastric peritoneoscopy Diagnostic findings between the two methods were compared and operative times and clinical course were recorded Definitive care was based on findings at diagnostic laparoscopyTen patients completed the protocol with an average age of 676 years All patients underwent diagnostic laparoscopy followed by successful transgastric access and diagnostic endoscopic peritoneoscopy The average time of diagnostic laparoscopy was 123 minutes compared to 248 minutes for the transgastric route Transgastric abdominal exploration corroborated the decision to proceed to open exploration made during traditional laparoscopic exploration in 9 of 10 patients Peritoneal or liver biopsies were obtained in four patients by traditional laparoscopy and in one patient by the transgastric access route Findings were confirmed by laparotomy in nine patients Eight patients underwent pancreaticoduodenectomy and two underwent palliative gastrojejunostomy and/or hepaticojejunostomyTransgastric diagnostic peritoneoscopy is safe and feasible This study demonstrates the initial steps of NOTES in humans providing a potential platform for incisionless surgery Technical issues including instrumentation visualization intraabdominal manipulation and gastric closure need further development
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