title: Rendezvous gastrotomy technique using direct percutaneous endoscopic gastrostomy for transgastric cholecystectomy in hybrid natural orifice translumenal endoscopic surgery.
abstract: OBJECTIVE
  Transgastric access is a major route in natural orifice translumenal endoscopic surgery (NOTES); gastrotomy should be performed unless it would damage surrounding organs in the peritoneal cavity. This article describes a novel rendezvous gastrotomy technique over a direct percutaneous endoscopic gastrostomy (PEG).
  
  
  METHODS
  In six live porcines, the gastrotomy involved applying a direct PEG through the abdominal wall into the stomach and exchanging to a needle trocar. An endoscopic balloon catheter was passed through the trocar by rendezvous technique. Then the inflated balloon and endoscope were advanced to the peritoneal cavity through the gastrotomy. Transgastric cholecystectomy was performed with a hybrid needle grasper through the same percutaneous site and the gastrotomy was closed with endoscopic clips.
  
  
  RESULTS
  The rendezvous gastrotomy technique could reduce guidewire exchange. The success rate was 100% (6/6). Mean times for transgastric peritoneoscopy and cholecystectomy were 25.5 and 83.5 min. Mortality and morbidity was 0%. The addition of the extra trocar was unnecessary in all procedures.
  
  
  CONCLUSIONS
  The advantage of this introduction system includes the creation of controlled gastric perforation, which is easier to close. It provides reliable transgastric access and increases safety. It simplifies transgastric NOTES and provides less invasive hybrid NOTES procedure.
authors: Department of Surgery, Teikyo University Chiba Medical Center, 3426-3 Anesaki, Ichihara, Chiba, 299-0111, Japan. sugimototeikyo@gmail.com
authors: Maki
authors: M
authors: Sugimoto
authors: Hideki
authors: H
authors: Yasuda
authors: Keiji
authors: K
authors: Koda
authors: Masato
authors: M
authors: Suzuki
authors: Masato
authors: M
authors: Yamazaki
authors: Tohru
authors: T
authors: Tezuka
authors: Chihiro
authors: C
authors: Kosugi
authors: Ryota
authors: R
authors: Higuchi
authors: Yoshihisa
authors: Y
authors: Watayo
authors: Yohsuke
authors: Y
authors: Yagawa
authors: Shuichiro
authors: S
authors: Uemura
authors: Hironori
authors: H
authors: Tsuchiya
authors: Atsushi
authors: A
authors: Hirano
authors: Ro
authors: R
authors: Shoki
mesh_terms: D000818:Animals; D002763:Cholecystectomy / Q000379:methods*; D004724:Endoscopy / Q000379:methods*; D005773:Gastroscopy / Q000379:methods*; D005774:Gastrostomy / Q000379:methods*; D008488:Medical Illustration; D011677:Punctures / Q000379:methods; D013552:Swine