Evaluation of endoscopy in localizing transgastric access for natural orifice transluminal endoscopic surgery in humans.
BACKGROUND: To date, transgastric access in humans for natural orifice transluminal endoscopic surgery (NOTES) has been poorly evaluated. OBJECTIVE: To compare endoscopic visualization of the transgastric access point with the laparoscopically defined ideal entrance to the peritoneal cavity. DESIGN:...
| Publicado en: | Gastrointestinal Endoscopy Vol. 71; no. 6; pp. 907 - 913 |
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| Autores principales: | , , , , , , |
| Formato: | pictorial research tables/charts Journal Article |
| Publicado: |
Elsevier B.V.
May2010
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105204628&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 105204628 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 00165107 4A9 jtl: Gastrointestinal Endoscopy issn: 00165107 maglogo: N pubinfo: dt: May2010 vid: 71 iid: 6 pid: 467 pub: Elsevier B.V. place: New York, New York artinfo: ui: 105204628 2010659052 10.1016/j.gie.2009.11.041 NLM20226453 105204628 ppf: 907 ppct: 6 formats: tig: atl: Evaluation of endoscopy in localizing transgastric access for natural orifice transluminal endoscopic surgery in humans. aug: au: Linke GR Zerz A Kapitza F Warschkow R Lange J Meyenberger CM Binek J affil: Department of Surgery, Kantonsspital St. Gallen, St. Gallen, Switzerland sug: subj: Endoscopy Methods Minimally Invasive Procedures Pneumoperitoneum Body Mass Index Data Analysis Software Demography Equipment and Supplies Human Pilot Studies Post Hoc Analysis Spearman's Rank Correlation Coefficient Switzerland ab: BACKGROUND: To date, transgastric access in humans for natural orifice transluminal endoscopic surgery (NOTES) has been poorly evaluated. OBJECTIVE: To compare endoscopic visualization of the transgastric access point with the laparoscopically defined ideal entrance to the peritoneal cavity. DESIGN: Prospective pilot study in humans. SETTING: Single tertiary-care center. PATIENTS: This study involved 31 patients referred for laparoscopic cholecystectomy. INTERVENTION: Access points were marked by endoscopy alone, endoscopy combined with diaphanoscopy, and endoscopy after pneumoperitoneum. Points were correlated with a laparoscopically visualized, previously defined ideal access area. MAIN OUTCOME MEASUREMENTS: To choose the appropriate access point within the laparoscopically defined ideal access area to the peritoneal cavity away from major vessels and adjacent organs, by using endoscopy and to establish landmarks for the endoscopist, look for a learning curve, and identify potential problems. RESULTS: The percentage of access points within the laparoscopically defined ideal area was 35.5% with endoscopy alone, 13.8% using the diaphanoscopy method, and 45.2% after transcutaneous pneumoperitoneum. A safe access point (> or = 3 cm from major gastric vessels) could be achieved with the 3 techniques in 83.9%, 65.5%, and 87.1% of patients, respectively. A positive learning curve for endoscopic localization was identified before (P = .008) and after (P = .014) pneumoperitoneum. Virtual complications were greater in obese patients. LIMITATIONS: This was a small pilot study with hypothetical complications and problems, because actual transgastric access was not performed. The criteria for an ideal access area were very strict. CONCLUSION: Endoscopy, especially with the use of pneumoperitoneum, can reliably locate a safe transgastric entrance point. However, the endoscopically chosen site correlates poorly with the ideal laparoscopically determined site for transgastric access. pubtype: Academic Journal doctype: pictorial research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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