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

Abstract:

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 on 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.

journal_name

Gastrointest Endosc

authors

Dray X,Gabrielson KL,Buscaglia JM,Shin EJ,Giday SA,Surti VC,Assumpcao L,Marohn MR,Magno P,Pipitone LJ,Redding SK,Kalloo AN,Kantsevoy SV

doi

10.1016/j.gie.2007.12.052

subject

Has Abstract

pub_date

2008-09-01 00:00:00

pages

513-9

issue

3

eissn

0016-5107

issn

1097-6779

pii

S0016-5107(07)03361-5

journal_volume

68

pub_type

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