Feasibility of transgastric and transcolonic natural orifice transluminal endoscopic surgery peritoneoscopy combined with intraperitoneal EUS.
BACKGROUND
If natural orifice transluminal endoscopic surgery (NOTES) peritoneoscopy is to become an alternative to diagnostic laparoscopy, NOTES peritoneoscopy must be comparable to laparoscopy in its diagnostic accuracy.


OBJECTIVE
To assess the feasibility of transgastric (TG) and transcolonic (TC) NOTES peritoneoscopy combined with intraperitoneal EUS.


METHODS
Twelve nonsurvival experiments on 6 female pigs.


METHODS
Animal laboratory.


METHODS
Six 35- to 40-kg female pigs.


METHODS
Randomization was performed to determine the order of approach (TG or TC as first procedure). After peritoneal access, systematic peritoneoscopy was performed according to a preassessed list of 12 locations considered clinically important. For each visualized location, 1 point was scored and 1 point added if it was touched as well, leading to a maximum score of 24 points. Subsequently, the endoscope was exchanged for a linear EUS-scope. The percentage of visualization of the 4 sections of the liver was recorded (0, not visible; 1, 33%; 2, 66%; 3, 100%; maximum score, 12 points). After withdrawal, the protocol was repeated by using the second natural orifice (TG or TC).


METHODS
Extent of adequate visualization of diagnostic peritoneoscopy and intraperitoneal EUS measured by a preassessed record form.


RESULTS
Access was achieved without difficulties at all 12 sites. TG peritoneoscopy resulted in a median of 23 points (range 20-24) via the TC approach. A maximum of 24 points was recorded in all pigs (P = .102). TG-EUS resulted in a median of 11 points (range 6-12) and TC-EUS in a median of 12 points (range 8-12) (P = .317).


CONCLUSIONS
Lack of objective landmarks for EUS.


CONCLUSIONS
TG and TC NOTES peritoneoscopy combined with intraperitoneal EUS is technically feasible. Furthermore, NOTES peritoneoscopy and intraperitoneal EUS seem to result in adequate visualization of the peritoneal cavity and liver, respectively.
Voermans
Rogier P
RP
Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands.
van Berge Henegouwen
Mark I
MI
Bemelman
Willem A
WA
Fockens
Paul
P
D000818:Animals; D003106:Colon / Q000601:surgery; D019160:Endosonography / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D010535:Laparoscopy / Q000379:methods*; D023421:Models, Animal; D013270:Stomach / Q000601:surgery; D013552:Swine