title: Feasibility of transgastric and transcolonic natural orifice transluminal endoscopic surgery peritoneoscopy combined with intraperitoneal EUS.
abstract: 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.
authors.affiliation: Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Rogier P
authors.initials: RP
authors.lastname: Voermans
authors.forename: Mark I
authors.initials: MI
authors.lastname: van Berge Henegouwen
authors.forename: Willem A
authors.initials: WA
authors.lastname: Bemelman
authors.forename: Paul
authors.initials: P
authors.lastname: Fockens
mesh_terms: 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