Peroral transgastric organ resection: a feasibility study in pigs.
BACKGROUND
The feasibility of peroral transgastric peritoneoscopy, liver biopsy, and tubal ligation has been demonstrated in prior animal studies. This approach has the potential to reduce postoperative morbidity.


OBJECTIVE
To explore the technical challenges and complications of performing a transgastric organ resection.


METHODS
Two-week animal survival study.


METHODS
Five female Yorkshire pigs underwent peroral transgastric partial hysterectomy. With the animals under general anesthesia, a sterile esophageal overtube was placed and a gastric antibiotic lavage was performed. Subsequently, a needle-knife and through-the-scope dilating balloon were used to make an anterior gastric wall incision through which a therapeutic gastroscope was advanced into the peritoneal cavity. Endoscopes and instruments previously had been disinfected in a 2.4% glutaraldehyde bath or were disposable. An endoloop and polypectomy snare were used to resect a portion of the uterus, which was removed through the mouth. Gastric incision closure was attempted with endoclips. After 2 weeks of observation, necropsy was performed.


RESULTS
Transgastric partial hysterectomy was performed on all 5 animals. One animal became lethargic and febrile, so necropsy was performed on day 4. An incompletely closed gastric incision and suppurative peritonitis were found. A second animal developed a fever; necropsy performed on day 14 revealed a gastric abscess at the incision site and scattered abdominal pus. No complications were encountered in the 3 remaining animals, and necropsy revealed well-healed gastric incisions and no evidence of peritonitis.


CONCLUSIONS
Endoscopic transgastric partial hysterectomy is technically feasible in a porcine model. Strict sterility seems mandatory but cannot always be assured. Incomplete closure of the gastric incision may lead to significant complications.
Division of Gastroenterology, Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
Benjamin F
BF
Merrifield
Mihir S
MS
Wagh
Christopher C
CC
Thompson
D000818:Animals; D004195:Disease Models, Animal; D016099:Endoscopy, Gastrointestinal; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D007044:Hysterectomy / Q000379:methods* / Q000401:mortality; D009055:Mouth; D015203:Reproducibility of Results; D013270:Stomach; D015996:Survival Rate; D013552:Swine