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 Endoscjournal_title
Gastrointestinal endoscopyauthors
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 SVdoi
10.1016/j.gie.2007.12.052subject
Has Abstractpub_date
2008-09-01 00:00:00pages
513-9issue
3eissn
0016-5107issn
1097-6779pii
S0016-5107(07)03361-5journal_volume
68pub_type
杂志文章abstract::Endoscopic retrograde cholangiopancreatography is a valuable tool in the diagnosis and management of pancreaticobiliary diseases. The diagnostic sensitivity of brush cytology is reported as between 18% and 70% for malignant bile duct or pancreatic duct strictures. We report our findings in 74 patients with pancreatico...
journal_title:Gastrointestinal endoscopy
pub_type: 杂志文章
doi:10.1016/s0016-5107(94)70155-5
更新日期:1994-03-01 00:00:00
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journal_title:Gastrointestinal endoscopy
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journal_title:Gastrointestinal endoscopy
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更新日期:2002-09-01 00:00:00
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journal_title:Gastrointestinal endoscopy
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pub_type: 临床试验,杂志文章,多中心研究
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更新日期:2000-07-01 00:00:00
abstract::Fiberoptic upper gastrointestinal endoscopy has become an accepted procedure with recognized and acceptable complication rates. Recently, significant hypoxemia during upper gastrointestinal endoscopy has been identified. This report evaluates changes in arterial blood gases and investigates the effects of drugs, smoki...
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journal_title:Gastrointestinal endoscopy
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更新日期:2009-03-01 00:00:00
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更新日期:1988-01-01 00:00:00
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journal_title:Gastrointestinal endoscopy
pub_type: 临床试验,杂志文章,随机对照试验
doi:
更新日期:1994-11-01 00:00:00
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journal_title:Gastrointestinal endoscopy
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journal_title:Gastrointestinal endoscopy
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journal_title:Gastrointestinal endoscopy
pub_type: 杂志文章
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更新日期:2019-09-01 00:00:00
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更新日期:2004-04-01 00:00:00
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pub_type: 杂志文章
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更新日期:1996-12-01 00:00:00
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journal_title:Gastrointestinal endoscopy
pub_type: 杂志文章
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更新日期:2018-01-01 00:00:00
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journal_title:Gastrointestinal endoscopy
pub_type: 杂志文章
doi:10.1016/s0016-5107(94)70058-3
更新日期:1994-05-01 00:00:00
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journal_title:Gastrointestinal endoscopy
pub_type: 临床试验,杂志文章,随机对照试验
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更新日期:1997-10-01 00:00:00