title: Transgastric natural-orifice transluminal endoscopic surgery peritoneoscopy in humans: a pilot study in efficacy and gastrotomy site selection by using a hybrid technique.
abstract: BACKGROUND
  Diagnostic natural-orifice transluminal endoscopic surgery (NOTES) peritoneoscopy can easily be performed with standard endoscopic equipment in animal studies. The efficacy and optimal transgastric site for NOTES access in humans, however, has not been determined.
  
  
  OBJECTIVE
  To characterize the efficacy of various anterior gastric access locations for diagnostic transgastric NOTES peritoneoscopy in humans.
  
  
  METHODS
  Prospective clinical study.
  
  
  METHODS
  Tertiary-care center with experience in NOTES peritoneoscopy.
  
  
  METHODS
  Patients undergoing planned laparoscopic gastrectomy or gastrotomy involving the anterior aspect of the stomach were eligible.
  
  
  METHODS
  An anterior gastric site for NOTES gastrotomy was chosen and transgastric NOTES access was independently established after laparoscopic abdominal exploration. Peritoneoscopy was then performed. The site of gastrotomy was closed as part of the intended laparoscopic procedure.
  
  
  METHODS
  The ability to visualize the abdominal and pelvic organs in all four quadrants was determined. Patients were evaluated postoperatively for complications.
  
  
  RESULTS
  Eight patients requiring 9 procedures were studied. Gastrotomy sites were classified as body (n = 3), lesser curvature (n = 3), greater curvature (n = 1), fundus (n = 1), and antrum (n = 1). Satisfactory navigation could only be performed to the right upper and both lower quadrants. The left upper quadrant, specifically the spleen, was adequately visualized in only 1 case (11%), where the gastrotomy site was at the greater curvature. One patient developed a surgical site infection requiring oral antibiotic therapy. The median postoperative stay was 2 days (range, 0-3 days).
  
  
  CONCLUSIONS
  Small number of patients.
  
  
  CONCLUSIONS
  NOTES peritoneoscopy with a gastrotomy on the anterior stomach permits adequate visualization of organs in the right upper and both lower quadrants. Visualization of the left upper quadrant and spleen is, however, limited unless access is gained on the greater curvature of the stomach. The accuracy of NOTES in identifying intra-abdominal pathology compared with laparoscopy remains to be determined.
authors.affiliation: Department of Surgery, University Hospitals, Case Medical Center, Cleveland, Ohio 44106, USA.
authors.forename: Mehrdad
authors.initials: M
authors.lastname: Nikfarjam
authors.forename: Michael F
authors.initials: MF
authors.lastname: McGee
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Trunzo
authors.forename: Raymond P
authors.initials: RP
authors.lastname: Onders
authors.forename: Jonathan P
authors.initials: JP
authors.lastname: Pearl
authors.forename: Benjamin K
authors.initials: BK
authors.lastname: Poulose
authors.forename: Amitabh
authors.initials: A
authors.lastname: Chak
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Ponsky
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Marks
mesh_terms: D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D005743:Gastrectomy / Q000379:methods*; D005774:Gastrostomy; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D010865:Pilot Projects; D011446:Prospective Studies; D015203:Reproducibility of Results; D013274:Stomach Neoplasms / Q000601:surgery*; D016896:Treatment Outcome