And fluid leak tests after NOTES procedures: a pilot study in a live porcine model (with videos)

被引：36

作者：

Dray, Xavier ^{[1
,5
]}

Gabrielson, Kathleen L. ^{[2
]}

Buscaglia, Jonathan M. ^{[1
]}

Shin, Eun Ji ^{[1
]}

Giday, Samuel A. ^{[1
]}

Surti, Vihar C. ^{[6
]}

Assumpcao, Lia ^{[3
]}

Marohn, Michael R. ^{[3
]}

Magno, Priscilla ^{[1
,7
]}

Pipitone, Laurie J. ^{[4
]}

Redding, Susan K. ^{[4
]}

Kalloo, Anthony N. ^{[1
]}

Kantsevoy, Sergey V. ^{[1
]}

机构：

[1] Johns Hopkins Univ, Sch Med, Div Gastroenterol, Baltimore, MD 21205 USA

[2] Johns Hopkins Univ, Sch Med, Dept Mol & Comparat Pathobiol, Baltimore, MD 21205 USA

[3] Johns Hopkins Univ, Sch Med, Dept Surg, Baltimore, MD 21205 USA

[4] Johns Hopkins Univ, Sch Med, Dept Radiol, Baltimore, MD 21205 USA

[5] Hop Lariboisiere, Dept Digest Dis, F-75475 Paris, France

[6] Cook Endoscopy Inc, Winston Salem, NC USA

[7] Univ Puerto Rico, Dept Med, San Juan, PR 00936 USA

来源：

GASTROINTESTINAL ENDOSCOPY | 2008年 / 68卷 / 03期

关键词：

D O I：

10.1016/j.gie.2007.12.052

中图分类号：

R57 [消化系及腹部疾病];

学科分类号：

摘要：

Background: Transluminal access site closure remains a major challenge in natural orifice transluminal endoscopic Surgery (NOTES). Objective: Our purpose Was to develop in vivo leak tests for evaluation of the integrity of transgastric access closure. Settings: Survival experiments on 12 50-kg pigs. Design and Interventions: After a standardized transgastric approach to the peritoneal cavity and peritoneoscopy the gastric wall incision was closed with T-bars (Wilson-Cook Medical, Winston-Salem, NC) deployed on both sides of the incision and then cinched together. Gastrotomy closure was assessed with air and fluid leak tests. The animals were observed for 1 week and then underwent endoscopic evaluation and necropsy. Main Outcome Measurements: (1) Leak-proof closure of the gastric wall incision. (2) Gastric incision healing 1 week after the procedure. Results: The mean intraperitoneal pressure increased 10.7 +/- 3.7 mm Hg during gastric insufflation when the air leak test was performed before closure compared with 0.9 +/- 0.8 mm Hg after transmural closure of the transgastric access site with T-bars (P <.001). Fluid leak tests demonstrated no leakage of liquid contrast from the stomach into the peritoneal cavity after closure. Necropsy in 1 week confirmed completeness of the gastric closure in all animals with full-thickness healing and no spillage of the gastric contents into the peritoneal cavity. Limitations: Leak tests were only evaluated oil an animal model. Conclusions: Fluid and air leak tests are simple techniques to evaluate in vivo the adequacy of the transluminal access site closure after NOTES procedures. Leak-proof gastric closure resulted in adequate tissue approximation and full-thickness healing of the gastric wall incision.

引用

页码：513 / 519

页数：7

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