Diagnostic transgastric endoscopic peritoneoscopy: Extension of the initial human trial for staging of pancreatic head masses

Peter Nau, Joel Anderson, Benjamin Yuh, Peter Muscarella, E. Christopher Ellison, Lynn Happel, Vimal K. Narula, W. Scott Melvin, Jeffrey W. Hazey

Research output: Contribution to journalArticle

34 Citations (Scopus)

Abstract

Background The validity of natural orifice translumenal endoscopic surgery (NOTES) was confirmed in a human trial of 10 patients undergoing diagnostic transgastric endoscopic peritoneoscopy (DTEP) for staging of pancreatic head masses. This report is an update with 10 additional patients in the series and includes bacterial contamination data. Methods The patients in this human trial were scheduled to undergo diagnostic laparoscopy for abdominal staging of a pancreatic head mass. A second surgeon, blinded to the laparoscopic findings, performed a transgastric endoscopic peritoneoscopy (TEP). The findings of laparoscopic exploration were compared with that those of the TEP. Diagnostic findings, operative times, and clinical course were recorded. Bacterial contamination data were collected for the second cohort of 10 patients. Bacterial samples were collected from the scope before use and the abdominal cavity before and after creation of the gastrotomy. Samples were assessed for bacterial counts and species identification. Definitive care was rendered based on the findings from laparoscopy. Results In this study, 20 patients underwent diagnostic laparoscopy followed by DTEP. The average time for completion of diagnostic laparoscopy was 10 min compared with 21 min for TEP. The experience acquired during the initial 10 procedures translated to a 7-min decrease in TEP time for the second 10 cases. For 19 of the 20 patients, DTEP corroborated laparoscopic findings for surgical decision making. One endoscopic and five laparoscopic biopsieswere performed. Pancreaticoduodenectomy was performed for 14 patients and palliative gastrojejunostomyfor 6 patients.No cross-contamination of the peritoneum or infectious complications were noted. No significant complications related to either the endoscopic or laparoscopic approach occurred. Conclusions This study supports the authors' previous conclusions that the transgastric approach to diagnostic peritoneoscopy is feasible, safe, and accurate. The lack of documented bacterial contamination further supports the use of this technique. Technical issues, including intraabdominal manipulation and gastric closure, require further investigation.

Original languageEnglish (US)
Pages (from-to)1440-1446
Number of pages7
JournalSurgical Endoscopy and Other Interventional Techniques
Volume24
Issue number6
DOIs
StatePublished - Jun 2010
Externally publishedYes

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Laparoscopy
Natural Orifice Endoscopic Surgery
Pancreaticoduodenectomy
Abdominal Cavity
Bacterial Load
Peritoneum
Operative Time
Stomach
Decision Making

Keywords

  • Endolumenal surgery
  • Natural orifice translumenal endoscopic surgery
  • Transgastric surgery

ASJC Scopus subject areas

  • Surgery
  • Medicine(all)

Cite this

Diagnostic transgastric endoscopic peritoneoscopy : Extension of the initial human trial for staging of pancreatic head masses. / Nau, Peter; Anderson, Joel; Yuh, Benjamin; Muscarella, Peter; Ellison, E. Christopher; Happel, Lynn; Narula, Vimal K.; Melvin, W. Scott; Hazey, Jeffrey W.

In: Surgical Endoscopy and Other Interventional Techniques, Vol. 24, No. 6, 06.2010, p. 1440-1446.

Research output: Contribution to journalArticle

Nau, Peter ; Anderson, Joel ; Yuh, Benjamin ; Muscarella, Peter ; Ellison, E. Christopher ; Happel, Lynn ; Narula, Vimal K. ; Melvin, W. Scott ; Hazey, Jeffrey W. / Diagnostic transgastric endoscopic peritoneoscopy : Extension of the initial human trial for staging of pancreatic head masses. In: Surgical Endoscopy and Other Interventional Techniques. 2010 ; Vol. 24, No. 6. pp. 1440-1446.
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AU - Nau, Peter

AU - Anderson, Joel

AU - Yuh, Benjamin

AU - Muscarella, Peter

AU - Ellison, E. Christopher

AU - Happel, Lynn

AU - Narula, Vimal K.

AU - Melvin, W. Scott

AU - Hazey, Jeffrey W.

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AB - Background The validity of natural orifice translumenal endoscopic surgery (NOTES) was confirmed in a human trial of 10 patients undergoing diagnostic transgastric endoscopic peritoneoscopy (DTEP) for staging of pancreatic head masses. This report is an update with 10 additional patients in the series and includes bacterial contamination data. Methods The patients in this human trial were scheduled to undergo diagnostic laparoscopy for abdominal staging of a pancreatic head mass. A second surgeon, blinded to the laparoscopic findings, performed a transgastric endoscopic peritoneoscopy (TEP). The findings of laparoscopic exploration were compared with that those of the TEP. Diagnostic findings, operative times, and clinical course were recorded. Bacterial contamination data were collected for the second cohort of 10 patients. Bacterial samples were collected from the scope before use and the abdominal cavity before and after creation of the gastrotomy. Samples were assessed for bacterial counts and species identification. Definitive care was rendered based on the findings from laparoscopy. Results In this study, 20 patients underwent diagnostic laparoscopy followed by DTEP. The average time for completion of diagnostic laparoscopy was 10 min compared with 21 min for TEP. The experience acquired during the initial 10 procedures translated to a 7-min decrease in TEP time for the second 10 cases. For 19 of the 20 patients, DTEP corroborated laparoscopic findings for surgical decision making. One endoscopic and five laparoscopic biopsieswere performed. Pancreaticoduodenectomy was performed for 14 patients and palliative gastrojejunostomyfor 6 patients.No cross-contamination of the peritoneum or infectious complications were noted. No significant complications related to either the endoscopic or laparoscopic approach occurred. Conclusions This study supports the authors' previous conclusions that the transgastric approach to diagnostic peritoneoscopy is feasible, safe, and accurate. The lack of documented bacterial contamination further supports the use of this technique. Technical issues, including intraabdominal manipulation and gastric closure, require further investigation.

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