title: Peroral transgastric endoscopic procedures in pigs: feasibility, survival, questionings, and pitfalls.
abstract: BACKGROUND
  Multiple studies have demonstrated the feasibility of peroral transgastric endoscopic procedures in porcine models. We present our experience with these procedures in a porcine survival model and expose the technical difficulties and worries about their application in humans.
  
  
  METHODS
  We performed the following transgastric procedures in nine small pigs (20-30 kg) under general anesthesia using a double-channel therapeutic endoscope: peritoneoscopy (nine pigs), cholecystectomy (six pigs), gastrojejunal anastomosis (two pigs), and fallopian tube excision (one pig). Postsurgical complications and survival of the pigs were recorded during a 3-week follow-up.
  
  
  RESULTS
  In six pigs, the gallbladder was successfully resected. The time of the procedure ranged from 2.5 to 3.5 hours. In one case, severe bleeding occurred from the cystic artery during dissection and was successfully managed by placement of endoscopic clips. Five pigs survived for 3 weeks after cholecystectomy. In one pig, severe peritonitis developed because of gastric contents leakage due to failure of gastric closure and the animal was euthanized 3 days after the procedure. Endoscopic transgastric gastrojejunostomy was successfully performed in two pigs without major complications. The time required for the procedure averaged about 50 min. Fallopian tube excision was also successful in one pig without any complications. The entire procedure was performed within 60 min.
  
  
  CONCLUSIONS
  This study reports the feasibility of natural orifice transluminal endoscopic surgery (NOTES) procedures in a porcine survival model and impresses the efficacy, the safety, the complications, and some technical difficulties of transgastric NOTES procedures, which merit further evaluation in future studies.
authors.affiliation: Laboratory of Experimental Surgery and Surgical Research, School of Medicine, Democritus University of Thrace, Alexandroupolis, Thrace, Greece.
authors.forename: Constantinos
authors.initials: C
authors.lastname: Simopoulos
authors.forename: Georgios
authors.initials: G
authors.lastname: Kouklakis
authors.forename: Petros
authors.initials: P
authors.lastname: Zezos
authors.forename: Petros
authors.initials: P
authors.lastname: Ypsilantis
authors.forename: Sotiris
authors.initials: S
authors.lastname: Botaitis
authors.forename: Christos
authors.initials: C
authors.lastname: Tsalikidis
authors.forename: Michail
authors.initials: M
authors.lastname: Pitiakoudis
mesh_terms: D000818:Animals; D002763:Cholecystectomy / Q000379:methods*; D004724:Endoscopy / Q000379:methods*; D005187:Fallopian Tubes / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D015390:Gastric Bypass / Q000379:methods*; D020699:Gastroscopes; D008297:Male; D023421:Models, Animal; D010529:Peritoneal Cavity / Q000601:surgery*; D013552:Swine