Rendezvous gastrotomy technique using direct percutaneous endoscopic gastrostomy for transgastric cholecystectomy in hybrid natural orifice translumenal endoscopic surgery.
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.
Sugimoto
Maki
M
Department of Surgery, Teikyo University Chiba Medical Center, 3426-3 Anesaki, Ichihara, Chiba, 299-0111, Japan. sugimototeikyo@gmail.com
Yasuda
Hideki
H
Koda
Keiji
K
Suzuki
Masato
M
Yamazaki
Masato
M
Tezuka
Tohru
T
Kosugi
Chihiro
C
Higuchi
Ryota
R
Watayo
Yoshihisa
Y
Yagawa
Yohsuke
Y
Uemura
Shuichiro
S
Tsuchiya
Hironori
H
Hirano
Atsushi
A
Shoki
Ro
R
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