title: Transgastric organ resection solely with the prototype R-scope and the self-approximating transluminal access technique.
abstract: BACKGROUND
  The self-approximating transluminal access technique (STAT) has been demonstrated to provide safe transluminal access and in-line endoscope positioning to target abdominal organs during natural orifice transluminal endoscopic surgery (NOTES). To date, organ resection with NOTES has typically required percutaneous assistance. We hypothesized that the in-line positioning and partial stability provided by STAT would allow single-access NOTES procedures if a multiarticulated endoscope could be used.
  
  
  OBJECTIVE
  Assessment of single-site NOTES, using STAT and a prototype, multi-articulated endoscope.
  
  
  METHODS
  Animal survival study.
  
  
  METHODS
  Penn State Hershey Medical Center Research Laboratories.
  
  
  METHODS
  Thirteen pigs underwent NOTES using a prototype endoscope with 2 articulated channels, a grasping forceps, and an insulated-tip needle-knife. The gallbladder was dissected using a fundus down technique, and hemoclips and a detachable loop were placed on the cystic duct and artery before removal. After a 2- to 3-week observation period, animals were euthanized and necropsy performed.
  
  
  RESULTS
  All target organs were successfully resected without laparoscopic assistance. Significant complications were 2 perforations (1 caused by a prototype duodenal occlusion device and 1 caused by enterotomy during cholecystectomy) and 1 entrapment of the small bowel with an endoloop. Postoperatively, all animals gained weight appropriately with 1 killed on postoperative day 12 because of lethargy (cystic duct leak/biloma).
  
  
  CONCLUSIONS
  This is a limited animal survival study without control arm.
  
  
  CONCLUSIONS
  The combination of the R-scope and STAT does allow effective, single-site NOTES procedures; however, although the R-scope provides improved tissue manipulation and visibility, the complications incurred here suggest that further improvements in devices and technique will be required for safe and effective single-site NOTES procedures.
authors.affiliation: Division of Gastroenterology/Hepatology, Penn State Hershey Medical Center, Hershey, Pennsylvania 17033, USA.
authors.forename: Matthew T
authors.initials: MT
authors.lastname: Moyer
authors.forename: Randy S
authors.initials: RS
authors.lastname: Haluck
authors.forename: Jegan
authors.initials: J
authors.lastname: Gopal
authors.forename: Eric M
authors.initials: EM
authors.lastname: Pauli
authors.forename: Abraham
authors.initials: A
authors.lastname: Mathew
mesh_terms: D000818:Animals; D001658:Biliary Fistula / Q000473:pathology; D002763:Cholecystectomy / Q000295:instrumentation*; D003549:Cystic Duct / Q000473:pathology / Q000601:surgery; D004867:Equipment Design; D005260:Female; D005704:Gallbladder / Q000473:pathology; D020699:Gastroscopes; D007415:Intestinal Obstruction / Q000473:pathology; D019060:Minimally Invasive Surgical Procedures / Q000295:instrumentation*; D011183:Postoperative Complications / Q000473:pathology; D013525:Surgical Instruments; D013552:Swine; D000267:Tissue Adhesions / Q000473:pathology; D014599:Uterus / Q000473:pathology / Q000601:surgery*