title: Roux-en-Y gastrojejunal bypass using a hybrid NOTES-12 mm trocar technique in a porcine model.
abstract: OBJECTIVE
  To evaluate the feasibility and safety of Roux-en-Y gastrojejunal bypass procedure using a hybrid NOTES-12 mm trocar technique in a survival porcine model.
  
  
  METHODS
  The procedure was carried out on ten pigs. Two gastroscopes were introduced through the mouth and through a 12 mm trocar, respectively. A mechanical circular gastro-jejunal anastomosis was created by introducing a stapler after the trocar incision was enlarged. A 21 mm EEA OrVil circular stapler was utilized in the first six pigs and a 25 mm one was used in the other four. All pigs were fed beginning 24 hours after the procedure and were euthanized three weeks later.
  
  
  RESULTS
  The procedure was successfully completed in all ten animals. The mean length of the skin incision was 2.5 cm. All pigs survived without complications. Endoscopic inspection detected anastomotic strictures in 5/6 of the 21 mm-stapler and in 0/4 of the 25 mm-stapler anastomoses (p < 0.05).
  
  
  CONCLUSIONS
  Roux-en-Y gastrojejunal bypass using a hybrid NOTES-single 12 mm trocar access technique is a simple and safe procedure in a survival porcine model. Functional results need to be evaluated by further studies.
authors.affiliation: a Department of Surgery, Oncology and Gastroenterology , University of Padova , Padova , Italy ;
authors.forename: Lino
authors.initials: L
authors.lastname: Polese
authors.affiliation: b Section of Anatomy, Department of Molecular Medicine , University of Padova , Padova , Italy ;
authors.forename: Andrea
authors.initials: A
authors.lastname: Porzionato
authors.affiliation: c Department of Experimental Surgery , University of Padova , Padova , Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Luisetto
authors.affiliation: a Department of Surgery, Oncology and Gastroenterology , University of Padova , Padova , Italy ;
authors.forename: Doralba
authors.initials: D
authors.lastname: Mastrogiacomo
authors.affiliation: b Section of Anatomy, Department of Molecular Medicine , University of Padova , Padova , Italy ;
authors.forename: Veronica
authors.initials: V
authors.lastname: Macchi
authors.affiliation: b Section of Anatomy, Department of Molecular Medicine , University of Padova , Padova , Italy ;
authors.forename: Raffaele
authors.initials: R
authors.lastname: De Caro
authors.affiliation: a Department of Surgery, Oncology and Gastroenterology , University of Padova , Padova , Italy ;
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Norberto
authors.affiliation: a Department of Surgery, Oncology and Gastroenterology , University of Padova , Padova , Italy ;
authors.forename: Stefano
authors.initials: S
authors.lastname: Merigliano
mesh_terms: D000713:Anastomosis, Roux-en-Y / Q000379:methods; D000818:Animals; D005240:Feasibility Studies; D015390:Gastric Bypass / Q000379:methods*; D020699:Gastroscopes; D023421:Models, Animal; D057605:Natural Orifice Endoscopic Surgery / Q000379:methods*; D017792:Surgical Stapling / Q000379:methods*; D013552:Swine
keywords: Gastrojejunal bypass; NOTES; Roux-en-Y