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Jeffrey M Marks - One of the best experts on this subject based on the ideXlab platform.
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Transgastric natural-orifice transluminal endoscopic surgery peritoneoscopy in humans: a pilot study in efficacy and Gastrotomy site selection by using a hybrid technique
Gastrointestinal endoscopy, 2010Co-Authors: Mehrdad Nikfarjam, Joseph A Trunzo, Benjamin K Poulose, Michael F Mcgee, Jeffrey L Ponsky, Jonathan P Pearl, Raymond P. Onders, Amitabh Chak, Jeffrey M MarksAbstract: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. Design Prospective clinical study. Setting Tertiary-care center with experience in NOTES peritoneoscopy. Patients Patients undergoing planned laparoscopic gastrectomy or Gastrotomy involving the anterior aspect of the stomach were eligible. Interventions 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. Main Outcome Measures 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). Limitations Small number of patients. Conclusion 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.
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facilitating Gastrotomy closure during natural orifice transluminal endoscopic surgery using tissue anchors
Endoscopy, 2009Co-Authors: Joseph A Trunzo, Leandro Totti Cavazzola, B J Elmunzer, Benjamin K Poulose, Michael F Mcgee, S Schomish, Jeffrey L Ponsky, Jeffrey M MarksAbstract:Background and study aims: Reliable and secure closure of the Gastrotomy after natural-orifice transluminal endoscopic surgery (NOTES) remains a critical step for widespread acceptance and use of this mode of surgery. We describe a novel method for Gastrotomy closure using endoscopic tissue anchors. Methods: A standard upper endoscopy and wire placement as used for percutaneous endoscopic gastrostomy placement was performed in five pigs. Prior to Gastrotomy, four tissue anchors were placed in four quadrants (1 cm away from the wire). A 12-mm Gastrotomy was created endoscopically using a combination of needle-knife and balloon dilation. After transgastric peritoneoscopy, the sutures were approximated using a device knotting element. One additional pair of sutures was placed after evaluation of the gastric closure. The animals underwent in vivo contrast fluoroscopy, methylene blue instillation, and bursting pressure studies for assessment of the closure site. Results: All animals studied showed complete sealing of the Gastrotomy site without evidence of leak on fluoroscopic imaging or at final post-mortem intragastric methylene blue instillation. Improved insufflation ability following Gastrotomy was also noted using this technique, which enhanced overall visualization during the closure. Conclusion: Positioning tissue anchors prior to creating a NOTES Gastrotomy was a feasible and reliable method to perform gastric closure. Follow-up survival studies will be warranted to support these preliminary findings.
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peg rescue a practical notes technique
Surgical Endoscopy and Other Interventional Techniques, 2007Co-Authors: Jeffrey M Marks, Jeffrey L Ponsky, Jonathan P Pearl, Michael F McgeeAbstract:Dislodged percutaneous endoscopic gastrostomy (PEG) tubes occur commonly and may require urgent surgical intervention in a susceptible patient population. Natural orifice translumenal endoscopic surgery (NOTES) may facilitate PEG rescue and avoid the morbidity associated with contemporary surgical techniques. We report a case of a dislodged PEG tube in the early post-operative period with evidence of incomplete gastrocutaneous tract formation and intra-abdominal leakage. Bedside transgastric NOTES exploration facilitated peritoneoscopy, evacuation of intra-abdominal fluid, and re-establishment of the PEG tube through the original Gastrotomy tract. Tube feeds were resumed and postoperative contrast fluoroscopy demonstrated no intra-abdominal leakage from the replaced PEG tube. No postoperative complications related to the NOTES procedure were noted at 30 days of follow-up. PEG rescue represents a unique, practical, and empowering application of the burgeoning experience of NOTES.
Michael F Mcgee - One of the best experts on this subject based on the ideXlab platform.
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Transgastric natural-orifice transluminal endoscopic surgery peritoneoscopy in humans: a pilot study in efficacy and Gastrotomy site selection by using a hybrid technique
Gastrointestinal endoscopy, 2010Co-Authors: Mehrdad Nikfarjam, Joseph A Trunzo, Benjamin K Poulose, Michael F Mcgee, Jeffrey L Ponsky, Jonathan P Pearl, Raymond P. Onders, Amitabh Chak, Jeffrey M MarksAbstract: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. Design Prospective clinical study. Setting Tertiary-care center with experience in NOTES peritoneoscopy. Patients Patients undergoing planned laparoscopic gastrectomy or Gastrotomy involving the anterior aspect of the stomach were eligible. Interventions 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. Main Outcome Measures 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). Limitations Small number of patients. Conclusion 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.
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facilitating Gastrotomy closure during natural orifice transluminal endoscopic surgery using tissue anchors
Endoscopy, 2009Co-Authors: Joseph A Trunzo, Leandro Totti Cavazzola, B J Elmunzer, Benjamin K Poulose, Michael F Mcgee, S Schomish, Jeffrey L Ponsky, Jeffrey M MarksAbstract:Background and study aims: Reliable and secure closure of the Gastrotomy after natural-orifice transluminal endoscopic surgery (NOTES) remains a critical step for widespread acceptance and use of this mode of surgery. We describe a novel method for Gastrotomy closure using endoscopic tissue anchors. Methods: A standard upper endoscopy and wire placement as used for percutaneous endoscopic gastrostomy placement was performed in five pigs. Prior to Gastrotomy, four tissue anchors were placed in four quadrants (1 cm away from the wire). A 12-mm Gastrotomy was created endoscopically using a combination of needle-knife and balloon dilation. After transgastric peritoneoscopy, the sutures were approximated using a device knotting element. One additional pair of sutures was placed after evaluation of the gastric closure. The animals underwent in vivo contrast fluoroscopy, methylene blue instillation, and bursting pressure studies for assessment of the closure site. Results: All animals studied showed complete sealing of the Gastrotomy site without evidence of leak on fluoroscopic imaging or at final post-mortem intragastric methylene blue instillation. Improved insufflation ability following Gastrotomy was also noted using this technique, which enhanced overall visualization during the closure. Conclusion: Positioning tissue anchors prior to creating a NOTES Gastrotomy was a feasible and reliable method to perform gastric closure. Follow-up survival studies will be warranted to support these preliminary findings.
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peg rescue a practical notes technique
Surgical Endoscopy and Other Interventional Techniques, 2007Co-Authors: Jeffrey M Marks, Jeffrey L Ponsky, Jonathan P Pearl, Michael F McgeeAbstract:Dislodged percutaneous endoscopic gastrostomy (PEG) tubes occur commonly and may require urgent surgical intervention in a susceptible patient population. Natural orifice translumenal endoscopic surgery (NOTES) may facilitate PEG rescue and avoid the morbidity associated with contemporary surgical techniques. We report a case of a dislodged PEG tube in the early post-operative period with evidence of incomplete gastrocutaneous tract formation and intra-abdominal leakage. Bedside transgastric NOTES exploration facilitated peritoneoscopy, evacuation of intra-abdominal fluid, and re-establishment of the PEG tube through the original Gastrotomy tract. Tube feeds were resumed and postoperative contrast fluoroscopy demonstrated no intra-abdominal leakage from the replaced PEG tube. No postoperative complications related to the NOTES procedure were noted at 30 days of follow-up. PEG rescue represents a unique, practical, and empowering application of the burgeoning experience of NOTES.
Jeffrey L Ponsky - One of the best experts on this subject based on the ideXlab platform.
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Transgastric natural-orifice transluminal endoscopic surgery peritoneoscopy in humans: a pilot study in efficacy and Gastrotomy site selection by using a hybrid technique
Gastrointestinal endoscopy, 2010Co-Authors: Mehrdad Nikfarjam, Joseph A Trunzo, Benjamin K Poulose, Michael F Mcgee, Jeffrey L Ponsky, Jonathan P Pearl, Raymond P. Onders, Amitabh Chak, Jeffrey M MarksAbstract: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. Design Prospective clinical study. Setting Tertiary-care center with experience in NOTES peritoneoscopy. Patients Patients undergoing planned laparoscopic gastrectomy or Gastrotomy involving the anterior aspect of the stomach were eligible. Interventions 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. Main Outcome Measures 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). Limitations Small number of patients. Conclusion 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.
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facilitating Gastrotomy closure during natural orifice transluminal endoscopic surgery using tissue anchors
Endoscopy, 2009Co-Authors: Joseph A Trunzo, Leandro Totti Cavazzola, B J Elmunzer, Benjamin K Poulose, Michael F Mcgee, S Schomish, Jeffrey L Ponsky, Jeffrey M MarksAbstract:Background and study aims: Reliable and secure closure of the Gastrotomy after natural-orifice transluminal endoscopic surgery (NOTES) remains a critical step for widespread acceptance and use of this mode of surgery. We describe a novel method for Gastrotomy closure using endoscopic tissue anchors. Methods: A standard upper endoscopy and wire placement as used for percutaneous endoscopic gastrostomy placement was performed in five pigs. Prior to Gastrotomy, four tissue anchors were placed in four quadrants (1 cm away from the wire). A 12-mm Gastrotomy was created endoscopically using a combination of needle-knife and balloon dilation. After transgastric peritoneoscopy, the sutures were approximated using a device knotting element. One additional pair of sutures was placed after evaluation of the gastric closure. The animals underwent in vivo contrast fluoroscopy, methylene blue instillation, and bursting pressure studies for assessment of the closure site. Results: All animals studied showed complete sealing of the Gastrotomy site without evidence of leak on fluoroscopic imaging or at final post-mortem intragastric methylene blue instillation. Improved insufflation ability following Gastrotomy was also noted using this technique, which enhanced overall visualization during the closure. Conclusion: Positioning tissue anchors prior to creating a NOTES Gastrotomy was a feasible and reliable method to perform gastric closure. Follow-up survival studies will be warranted to support these preliminary findings.
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peg rescue a practical notes technique
Surgical Endoscopy and Other Interventional Techniques, 2007Co-Authors: Jeffrey M Marks, Jeffrey L Ponsky, Jonathan P Pearl, Michael F McgeeAbstract:Dislodged percutaneous endoscopic gastrostomy (PEG) tubes occur commonly and may require urgent surgical intervention in a susceptible patient population. Natural orifice translumenal endoscopic surgery (NOTES) may facilitate PEG rescue and avoid the morbidity associated with contemporary surgical techniques. We report a case of a dislodged PEG tube in the early post-operative period with evidence of incomplete gastrocutaneous tract formation and intra-abdominal leakage. Bedside transgastric NOTES exploration facilitated peritoneoscopy, evacuation of intra-abdominal fluid, and re-establishment of the PEG tube through the original Gastrotomy tract. Tube feeds were resumed and postoperative contrast fluoroscopy demonstrated no intra-abdominal leakage from the replaced PEG tube. No postoperative complications related to the NOTES procedure were noted at 30 days of follow-up. PEG rescue represents a unique, practical, and empowering application of the burgeoning experience of NOTES.
Carla Rolanda - One of the best experts on this subject based on the ideXlab platform.
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in vivo assessment of Gastrotomy closure with over the scope clips in an experimental model for varicocelectomy with video
Gastrointestinal Endoscopy, 2009Co-Authors: Carla Rolanda, Estevao Lima, David Silva, Ivone Moreira, Jose M Pego, Guilherme Macedo, Jorge CorreiapintoAbstract:Background Gastrotomy closure remains the major limiting factor for human translation of transgastric surgery; the over-the-scope clip (OTSC) system was proposed as a possibility for this purpose. Transgastric access is good for a pelvic approach, making varicocelectomy a possible indication for natural orifice transluminal endoscopic surgery (NOTES). Objective To evaluate the reliability of the OTSC system in vivo after transgastric testicular vessel ligation (varicocelectomy model). Design There were 3 experimental groups (5 animals in each): groups 1 and 3, Gastrotomy dilation up to 18 mm, surgery was performed with a double-channel endoscope; group 2, Gastrotomy dilation up to 13 mm, surgery was performed with a single-channel endoscope. Setting Surgical Sciences Research Domain, Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal. Interventions Bilateral testicular vessel ligation by transgastric access. Gastrotomy closed with the largest version of OTSC system (12 mm): a single clip in groups 1 and 2, and 2 clips in group 3. Animals were monitored for 2 weeks, killed, and submitted for necropsy. Main Outcome Measurements Adequacy of closure and healing after the use of the OTSC system. Statistical analysis. Results Vessel ligation was easily achieved in all groups. Although differences in the complication rate did not reach statistical significance ( P = .099), there was a clear tendency for a better prognosis in groups 2 and 3 than group 1. In fact, only 2 animals from group 1 had complications related to incomplete Gastrotomy closure. Limitations Small number of animals per group; nonrandomized study. Conclusions The OTSC system was shown to be easy and efficient for Gastrotomy closure in a survival experimental model of varicocelectomy, when correctly matching the Gastrotomy size with the clip size and/or number.
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In vivo assessment of Gastrotomy closure with over-the-scope clips in an experimental model for varicocelectomy (with video)
Gastrointestinal endoscopy, 2009Co-Authors: Carla Rolanda, Estevao Lima, David Silva, Ivone Moreira, Jose M Pego, Guilherme Macedo, Jorge Correia-pintoAbstract:Background Gastrotomy closure remains the major limiting factor for human translation of transgastric surgery; the over-the-scope clip (OTSC) system was proposed as a possibility for this purpose. Transgastric access is good for a pelvic approach, making varicocelectomy a possible indication for natural orifice transluminal endoscopic surgery (NOTES). Objective To evaluate the reliability of the OTSC system in vivo after transgastric testicular vessel ligation (varicocelectomy model). Design There were 3 experimental groups (5 animals in each): groups 1 and 3, Gastrotomy dilation up to 18 mm, surgery was performed with a double-channel endoscope; group 2, Gastrotomy dilation up to 13 mm, surgery was performed with a single-channel endoscope. Setting Surgical Sciences Research Domain, Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal. Interventions Bilateral testicular vessel ligation by transgastric access. Gastrotomy closed with the largest version of OTSC system (12 mm): a single clip in groups 1 and 2, and 2 clips in group 3. Animals were monitored for 2 weeks, killed, and submitted for necropsy. Main Outcome Measurements Adequacy of closure and healing after the use of the OTSC system. Statistical analysis. Results Vessel ligation was easily achieved in all groups. Although differences in the complication rate did not reach statistical significance ( P = .099), there was a clear tendency for a better prognosis in groups 2 and 3 than group 1. In fact, only 2 animals from group 1 had complications related to incomplete Gastrotomy closure. Limitations Small number of animals per group; nonrandomized study. Conclusions The OTSC system was shown to be easy and efficient for Gastrotomy closure in a survival experimental model of varicocelectomy, when correctly matching the Gastrotomy size with the clip size and/or number.
David B. Earle - One of the best experts on this subject based on the ideXlab platform.
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Loop-Anchor Purse-String Closure of Gastrotomy in NOTES ® Procedures: Survival Studies in a Porcine Model
2016Co-Authors: John R. Romanelli, Christopher N. Chapman, Carolanne Lovewell, David B. EarleAbstract:Introduction: Transgastric NOTES ® procedures remain without a simple method to close the Gastrotomy. In four survival swine studies, we have tested a novel gastric closure device: the loop-anchor purse-string (LAPS) closure system. Methods: In four anesthetized pigs, an endoscopic Gastrotomy was performed. Four loop anchors were arrayed in a 2-cm square pattern around the Gastrotomy. The endoscope was passed into the abdominal cavity, and the Gastrotomy was cinched closed. Results: Procedure times ranged from 50-180 minutes. Three pigs survived 14 days. One animal wa
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Loop-Anchor Purse-String Closure of Gastrotomy in NOTES® Procedures: Survival Studies in a Porcine Model
Surgical innovation, 2010Co-Authors: John Romanelli, Carolanne Lovewell, David J. Desilets, Christopher Chapman, Vihar C. Surti, David B. EarleAbstract:Introduction: Transgastric NOTES® procedures remain without a simple method to close the Gastrotomy. In four survival swine studies, we have tested a novel gastric closure device: the loop-anchor purse-string (LAPS) closure system. Methods: In four anesthetized pigs, an endoscopic Gastrotomy was performed. Four loop anchors were arrayed in a 2-cm square pattern around the Gastrotomy. The endoscope was passed into the abdominal cavity, and the Gastrotomy was cinched closed. Results: Procedure times ranged from 50-180 minutes. Three pigs survived 14 days. One animal was sacrificed early due to signs of sepsis. Another animal developed fevers and was treated with antibiotics. At necropsy, there were no abscesses, including in the septic animal. Histologic examination revealed evidence of healing in all animals. Discussion: The LAPS system holds promise with early success in an animal model. Future human studies are needed to determine viability as a human visceral closure device.
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Natural orifice transluminal endoscopic surgery Gastrotomy closure in porcine explants with the Padlock-G clip using the Lock-It system
Endoscopy, 2010Co-Authors: John Romanelli, David J. Desilets, David B. EarleAbstract:BACKGROUND AND STUDY AIMS: The success of transgastric surgery depends on reliable, secure closure of the Gastrotomy. Few tests of the integrity of these closures have been published. This study aimed to determine whether a Gastrotomy suitable for a NOTES procedure can be closed safely and effectively from within the stomach using a novel endoscopically placed device, the Padlock-G with the Lock-It delivery system. METHODS: In a series of eight consecutive porcine gastric explants Gastrotomy was performed in an ex vivo animal laboratory, the Gastrotomy being closed with the Padlock-G followed by burst pressure testing after completion of the procedure. Gastrotomies were made in porcine explants. T-tags were placed on either side of the Gastrotomy, and, with the T-tags pulled into an endoscopic cap, the Padlock-G was deployed. Gastric transmural pressure gradients at bursting of these closures were measured during insufflation of the explanted stomachs with a high-pressure insufflator. RESULTS: The mean burst pressure of the Gastrotomy closures was 68.0 mm Hg (range: 45 - 107 mm Hg). All of the stomachs ultimately ruptured at the closure sites, with the exception of the stomach that ruptured at the highest value (107 mm Hg), which ruptured at a site approximately 5 cm away from the closure site. All of the closures were accomplished in 30 minutes or less. CONCLUSIONS: The Padlock-G clip provides a secure gastric closure for natural-orifice surgery.
