Safe alternative transgastric peritoneal access in humans: NOTES

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

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

Background: Diagnostic transgastric endoscopic peritoneoscopy has been used to evaluate the abdomen. We present our experience with transgastric endoscopic peritoneoscopy (TEP) to access the peritoneum, direct trocar placement, and perform adhesiolysis without laparoscopic visualization in patients undergoing laparoscopic Roux-en-Y gastric bypass. Methods: Forty patients participated. There are 2 arms to the study. The initial 20 patients underwent pre-insufflation of the abdomen prior to TEP. The second 20 had no pre-insufflation. Ten patients in each arm had no surgical history. The other 10 had previous intra-abdominal procedures. TEP was performed through a gastrotomy created without laparoscopic visualization. Adhesions were visualized and taken down endoscopically prior to trocar placement. Diagnostic findings, operative times, and clinical course were recorded. Results: Average TEP time was 19 min. Three patients had limited visualization due to intra-abdominal adhesions (2) and omental fat (1). Three of the 20 without and 17 of 20 with a history of intra-abdominal surgery had adhesions visualized endoscopically. Endoscopic adhesiolysis was performed in 1 and 4 patients in these groups respectively. Six occult umbilical hernias, 1 inguinal hernia, and 1 hiatal hernia were noted on endoscopic exploration. There were no complications related to intubation of the stomach, accessing the peritoneum, or endoscopic exploration. Conclusion: TEP is a safe and accurate means to access the peritoneum, visualize the abdominal wall, perform adhesiolysis, and direct trocar placement without laparoscopic guidance. Safe and reliable gastric closure remains the sole limitation to its clinical use outside of a protocol necessitating a gastrotomy.

Original languageEnglish (US)
Pages (from-to)147-152
Number of pages6
JournalSurgery
Volume149
Issue number1
DOIs
StatePublished - Jan 2011
Externally publishedYes

Fingerprint

Laparoscopy
Peritoneum
Surgical Instruments
Insufflation
Abdomen
Stomach
Arm
Umbilical Hernia
Hiatal Hernia
Gastric Bypass
Inguinal Hernia
Abdominal Wall
Operative Time
Intubation
History
Fats

ASJC Scopus subject areas

  • Surgery

Cite this

Nau, P., Anderson, J., Happel, L., Yuh, B., Narula, V. K., Needleman, B., ... Hazey, J. W. (2011). Safe alternative transgastric peritoneal access in humans: NOTES. Surgery, 149(1), 147-152. https://doi.org/10.1016/j.surg.2009.10.060

Safe alternative transgastric peritoneal access in humans : NOTES. / Nau, Peter; Anderson, Joel; Happel, Lynn; Yuh, Benjamin; Narula, Vimal K.; Needleman, Bradley; Ellison, E. Christopher; Melvin, W. Scott; Hazey, Jeffrey W.

In: Surgery, Vol. 149, No. 1, 01.2011, p. 147-152.

Research output: Contribution to journalArticle

Nau, P, Anderson, J, Happel, L, Yuh, B, Narula, VK, Needleman, B, Ellison, EC, Melvin, WS & Hazey, JW 2011, 'Safe alternative transgastric peritoneal access in humans: NOTES', Surgery, vol. 149, no. 1, pp. 147-152. https://doi.org/10.1016/j.surg.2009.10.060
Nau P, Anderson J, Happel L, Yuh B, Narula VK, Needleman B et al. Safe alternative transgastric peritoneal access in humans: NOTES. Surgery. 2011 Jan;149(1):147-152. https://doi.org/10.1016/j.surg.2009.10.060
Nau, Peter ; Anderson, Joel ; Happel, Lynn ; Yuh, Benjamin ; Narula, Vimal K. ; Needleman, Bradley ; Ellison, E. Christopher ; Melvin, W. Scott ; Hazey, Jeffrey W. / Safe alternative transgastric peritoneal access in humans : NOTES. In: Surgery. 2011 ; Vol. 149, No. 1. pp. 147-152.
@article{36b5b1b533914b1a97b09b89a1623c3b,
title = "Safe alternative transgastric peritoneal access in humans: NOTES",
abstract = "Background: Diagnostic transgastric endoscopic peritoneoscopy has been used to evaluate the abdomen. We present our experience with transgastric endoscopic peritoneoscopy (TEP) to access the peritoneum, direct trocar placement, and perform adhesiolysis without laparoscopic visualization in patients undergoing laparoscopic Roux-en-Y gastric bypass. Methods: Forty patients participated. There are 2 arms to the study. The initial 20 patients underwent pre-insufflation of the abdomen prior to TEP. The second 20 had no pre-insufflation. Ten patients in each arm had no surgical history. The other 10 had previous intra-abdominal procedures. TEP was performed through a gastrotomy created without laparoscopic visualization. Adhesions were visualized and taken down endoscopically prior to trocar placement. Diagnostic findings, operative times, and clinical course were recorded. Results: Average TEP time was 19 min. Three patients had limited visualization due to intra-abdominal adhesions (2) and omental fat (1). Three of the 20 without and 17 of 20 with a history of intra-abdominal surgery had adhesions visualized endoscopically. Endoscopic adhesiolysis was performed in 1 and 4 patients in these groups respectively. Six occult umbilical hernias, 1 inguinal hernia, and 1 hiatal hernia were noted on endoscopic exploration. There were no complications related to intubation of the stomach, accessing the peritoneum, or endoscopic exploration. Conclusion: TEP is a safe and accurate means to access the peritoneum, visualize the abdominal wall, perform adhesiolysis, and direct trocar placement without laparoscopic guidance. Safe and reliable gastric closure remains the sole limitation to its clinical use outside of a protocol necessitating a gastrotomy.",
author = "Peter Nau and Joel Anderson and Lynn Happel and Benjamin Yuh and Narula, {Vimal K.} and Bradley Needleman and Ellison, {E. Christopher} and Melvin, {W. Scott} and Hazey, {Jeffrey W.}",
year = "2011",
month = "1",
doi = "10.1016/j.surg.2009.10.060",
language = "English (US)",
volume = "149",
pages = "147--152",
journal = "Surgery (United States)",
issn = "0039-6060",
publisher = "Mosby Inc.",
number = "1",

}

TY - JOUR

T1 - Safe alternative transgastric peritoneal access in humans

T2 - NOTES

AU - Nau, Peter

AU - Anderson, Joel

AU - Happel, Lynn

AU - Yuh, Benjamin

AU - Narula, Vimal K.

AU - Needleman, Bradley

AU - Ellison, E. Christopher

AU - Melvin, W. Scott

AU - Hazey, Jeffrey W.

PY - 2011/1

Y1 - 2011/1

N2 - Background: Diagnostic transgastric endoscopic peritoneoscopy has been used to evaluate the abdomen. We present our experience with transgastric endoscopic peritoneoscopy (TEP) to access the peritoneum, direct trocar placement, and perform adhesiolysis without laparoscopic visualization in patients undergoing laparoscopic Roux-en-Y gastric bypass. Methods: Forty patients participated. There are 2 arms to the study. The initial 20 patients underwent pre-insufflation of the abdomen prior to TEP. The second 20 had no pre-insufflation. Ten patients in each arm had no surgical history. The other 10 had previous intra-abdominal procedures. TEP was performed through a gastrotomy created without laparoscopic visualization. Adhesions were visualized and taken down endoscopically prior to trocar placement. Diagnostic findings, operative times, and clinical course were recorded. Results: Average TEP time was 19 min. Three patients had limited visualization due to intra-abdominal adhesions (2) and omental fat (1). Three of the 20 without and 17 of 20 with a history of intra-abdominal surgery had adhesions visualized endoscopically. Endoscopic adhesiolysis was performed in 1 and 4 patients in these groups respectively. Six occult umbilical hernias, 1 inguinal hernia, and 1 hiatal hernia were noted on endoscopic exploration. There were no complications related to intubation of the stomach, accessing the peritoneum, or endoscopic exploration. Conclusion: TEP is a safe and accurate means to access the peritoneum, visualize the abdominal wall, perform adhesiolysis, and direct trocar placement without laparoscopic guidance. Safe and reliable gastric closure remains the sole limitation to its clinical use outside of a protocol necessitating a gastrotomy.

AB - Background: Diagnostic transgastric endoscopic peritoneoscopy has been used to evaluate the abdomen. We present our experience with transgastric endoscopic peritoneoscopy (TEP) to access the peritoneum, direct trocar placement, and perform adhesiolysis without laparoscopic visualization in patients undergoing laparoscopic Roux-en-Y gastric bypass. Methods: Forty patients participated. There are 2 arms to the study. The initial 20 patients underwent pre-insufflation of the abdomen prior to TEP. The second 20 had no pre-insufflation. Ten patients in each arm had no surgical history. The other 10 had previous intra-abdominal procedures. TEP was performed through a gastrotomy created without laparoscopic visualization. Adhesions were visualized and taken down endoscopically prior to trocar placement. Diagnostic findings, operative times, and clinical course were recorded. Results: Average TEP time was 19 min. Three patients had limited visualization due to intra-abdominal adhesions (2) and omental fat (1). Three of the 20 without and 17 of 20 with a history of intra-abdominal surgery had adhesions visualized endoscopically. Endoscopic adhesiolysis was performed in 1 and 4 patients in these groups respectively. Six occult umbilical hernias, 1 inguinal hernia, and 1 hiatal hernia were noted on endoscopic exploration. There were no complications related to intubation of the stomach, accessing the peritoneum, or endoscopic exploration. Conclusion: TEP is a safe and accurate means to access the peritoneum, visualize the abdominal wall, perform adhesiolysis, and direct trocar placement without laparoscopic guidance. Safe and reliable gastric closure remains the sole limitation to its clinical use outside of a protocol necessitating a gastrotomy.

UR - http://www.scopus.com/inward/record.url?scp=78650179345&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=78650179345&partnerID=8YFLogxK

U2 - 10.1016/j.surg.2009.10.060

DO - 10.1016/j.surg.2009.10.060

M3 - Article

C2 - 20122706

AN - SCOPUS:78650179345

VL - 149

SP - 147

EP - 152

JO - Surgery (United States)

JF - Surgery (United States)

SN - 0039-6060

IS - 1

ER -