Abstract:
BACKGROUND:Transgastric flexible endoscopic surgery might offer advantages over open and laparoscopic surgery. The aim of this study was to develop methods for performing transgastric biliary endosurgery. METHODS:Cholecystectomies and biliary anastomoses were performed in 8 anesthetized pigs (27-30 kg) in nonsurvival studies. Two endoscopes passed perorally were inserted through the stomach wall after needle-knife incision. Endoscope-induced pneumoperitoneum allowed viewing and manipulation of the gallbladder with both endoscopes independently. The cystic duct was dissected, clipped, and transected. Cholecystectomy was performed with one of two methods: either by using two endoscopes, or a single endoscope and a 5-mm-diameter grasping instrument inserted transabdominally. Clips and sutures were used to attach the gallbladder to the stomach wall, and an incision was made to form a cholecystogastrostomy. In survival experiments in 8 pigs, transgastric incisions were closed with endoscopic sutures. RESULTS:The gallbladder was successfully removed in 8 pigs (nonsurvival experiments). The time for the procedure ranged from 2.5 hours to 40 minutes and decreased with experience. At postmortem examination, clips placed on the cystic duct and the artery were secure. An anastomosis was successfully formed between gallbladder and stomach in 3 pigs. In 8 pigs, full-thickness incisions in the stomach wall were closed with two to 4 stitches. All 8 pigs survived (median follow-up, 22 days; range 14-28 days). CONCLUSIONS:Transgastric gallbladder surgery, including cholecystectomy and biliary anastomosis, is feasible. Full-thickness gastric incisions were safely closed in survival studies. The efficacy and the safety of transgastric surgery merits further study.
journal_name
Gastrointest Endoscjournal_title
Gastrointestinal endoscopyauthors
Park PO,Bergström M,Ikeda K,Fritscher-Ravens A,Swain Pdoi
10.1016/s0016-5107(04)02774-9keywords:
subject
Has Abstractpub_date
2005-04-01 00:00:00pages
601-6issue
4eissn
0016-5107issn
1097-6779pii
S0016-5107(04)02774-9journal_volume
61pub_type
杂志文章abstract:BACKGROUND:This report describes the development and the clinical evaluation of a novel confocal endomicroscope for obtaining fluorescence images of cellular morphology of the mucosae of the upper- and the lower-GI tract in vivo. The work assessed the feasibility of performing in vivo microscopy at endoscopic examinati...
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更新日期:2009-10-01 00:00:00
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更新日期:2016-01-01 00:00:00
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