title: Experimental studies of transgastric gallbladder surgery: cholecystectomy and cholecystogastric anastomosis (videos).
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.
authors.affiliation: Department of Surgery, Sahlgrenska University Hospital/Ostra, Goteborg, Sweden.
authors.forename: Per-Ola
authors.initials: PO
authors.lastname: Park
authors.forename: Maria
authors.initials: M
authors.lastname: Bergström
authors.forename: Keiichi
authors.initials: K
authors.lastname: Ikeda
authors.forename: Annette
authors.initials: A
authors.lastname: Fritscher-Ravens
authors.forename: Paul
authors.initials: P
authors.lastname: Swain
mesh_terms: D000714:Anastomosis, Surgical / Q000379:methods*; D000818:Animals; D002763:Cholecystectomy / Q000379:methods*; D016145:Endoscopy, Digestive System / Q000379:methods*; D005240:Feasibility Studies; D005704:Gallbladder / Q000601:surgery*; D010865:Pilot Projects; D013270:Stomach / Q000601:surgery*; D013536:Suture Techniques; D013552:Swine