title: Natural orifices transluminal endoscopic surgery (NOTES): an overview of technical challenges and complications of transgastric procedures in anesthetized pigs.
abstract: OBJECTIVE
  Natural orifice transluminal endoscopic surgery (NOTES) is a new reality that is progressively gaining popularity in the scientific community. The aim of this study was to report the authors' experience with various peroral transgastric procedures performed on the porcine model. The technical difficulties and challenges that arose were also analyzed.
  
  
  METHODS
  Ten anesthetized pigs, divided into an acute (3) and a survival group (7) underwent the following procedures using a double channel endoscope: peritoneoscopy (10), cholecystectomy (6),splenectomy (3), and gastrojejunostomy (3).
  
  
  RESULTS
  All the procedures were completed successfully. There was one complication related to the gastric wall incision. In the survival experiment group all pigs (4) submitted to biliare procedures made an uncomplicated recovery after a follow-up period of 2 weeks. Gastrojejunostomies (3) were instead graved by one technical failure (anastomosis disruption at post-mortem examination) and one case of mortality (premature euthanasia for evidences of sepsis). Complete gastric cleansing was impossible to achieve and overinflation was a common problem. The creation of gastro-enteric anastomoses was technically difficult with the current available devices.
  
  
  CONCLUSIONS
  Transgastric endoscopic surgery is technically feasible in a porcine model. A new instrumentation is needed and could strongly help to overcome the technical difficulties highlighted. More extensive animal studies are mandatory in order to evaluate the benefits and the limitations of this new technique.
authors.affiliation: Department of Surgery and Advanced Technologies, Center for Technical Innovation in Surgery (ITC), University of Naples Federico II, School of Medicine, Naples, Italy. giovanni.depalma@unina.it
authors.forename: G D
authors.initials: GD
authors.lastname: De Palma
authors.forename: F
authors.initials: F
authors.lastname: Persico
authors.forename: S
authors.initials: S
authors.lastname: Masone
authors.forename: A
authors.initials: A
authors.lastname: Belli
authors.forename: M
authors.initials: M
authors.lastname: Rega
authors.forename: M
authors.initials: M
authors.lastname: Persico
authors.forename: S
authors.initials: S
authors.lastname: Siciliano
authors.forename: F
authors.initials: F
authors.lastname: Salvatori
authors.forename: G
authors.initials: G
authors.lastname: Mastrobuoni
authors.forename: F
authors.initials: F
authors.lastname: Maione
authors.forename: E
authors.initials: E
authors.lastname: Coppola Bottazzi
authors.forename: V
authors.initials: V
authors.lastname: Girardi
authors.forename: M
authors.initials: M
authors.lastname: Dionisi
authors.forename: G
authors.initials: G
authors.lastname: Persico
mesh_terms: D000758:Anesthesia; D000818:Animals; D016099:Endoscopy, Gastrointestinal / Q000009:adverse effects* / Q000379:methods*; D013270:Stomach; D013552:Swine