Current limitations in endoscopic CO₂ insufflation for NOTES: flow and pressure study.
BACKGROUND
Natural orifice transluminal endoscopic surgery (NOTES) requires fast and steady CO₂ insufflation into the intraluminal and intra-abdominal spaces through a flexible endoscope. However, an optimal endoscopic insufflation system has yet to be determined.


OBJECTIVE
To verify the performances of 2 currently available CO₂ insufflators in an experimental NOTES setting: (1) an automatic pressure-regulated surgical insufflator (UHI-3) and (2) a manual endoscopic insufflator (UCR).


METHODS
An inanimate bench study followed by an acute animal experiment.


METHODS
Osaka University and Olympus Research and Development Department.


METHODS
The UHI-3 or UCR was connected to an endoscope of differing length and diameter via an insufflating line of differing length and diameter. The flow rates at the tip of the endoscope (bench test), the time to establish pneumoperitoneum, and the time to re-establish pneumoperitoneum after forceful suction (porcine model) were obtained.


RESULTS
The UHI-3 failed to feed CO₂ through an insufflating channel but fed CO₂ via a working channel but required a large channel (>3 mm) and a wide insufflating line (>7 mm) to accomplish an acceptable flow rate. UCR fed CO₂ through the insufflating channel; however, the time taken to establish pneumoperitoneum and the time taken to re-establish pneumoperitoneum after forceful suction were longer compared with the time taken for UHI-3 insufflation via the working channel or laparoscopic cannula.


CONCLUSIONS
Bench/animal study with small sample numbers; no human trial.


CONCLUSIONS
The currently available CO₂ insufflators are not optimal for NOTES. Modification of an endoscopic insufflation system and/or development of a dedicated overtube with an insufflating function are therefore essential.
Nakajima
Kiyokazu
K
Department of Surgery, Osaka University Graduate School of Medicine, Yamadaoka, Osaka, Japan. knakajima@gesurg.med.osaka-u.ac.jp
Nishida
Toshirou
T
Milsom
Jeffrey W
JW
Takahashi
Tsuyoshi
T
Souma
Yoshihito
Y
Miyazaki
Yasuaki
Y
Iijima
Hideki
H
Mori
Masaki
M
Doki
Yuichiro
Y
D000818:Animals; D020776:Endoscopes, Gastrointestinal; D016099:Endoscopy, Gastrointestinal; D004869:Equipment Safety; D005260:Female; D006801:Humans; D007327:Insufflation / Q000295:instrumentation*; D023421:Models, Animal; D008954:Models, Biological; D057605:Natural Orifice Endoscopic Surgery / Q000295:instrumentation*; D011028:Pneumoperitoneum, Artificial / Q000295:instrumentation*; D015203:Reproducibility of Results; D012212:Rheology; D013552:Swine