Peritoneoscopy

Abstract: Background Natural-orifice translumenal endoscopic surgery (NOTES) is a possible advancement for surgical interventions. We initiated a pilot study in humans to investigate feasibility and develop the techniques and technology necessary for NOTES. Reported herein is the first human clinical trial of NOTES, performing transoral transgastric diagnostic peritoneoscopy.

Abstract: A novel approach to diagnostic and therapeutic interventions in the peritoneal cavity is described. More specifically, a technique for accessing the peritoneal cavity via the wall of the digestive tract is provided so that examination of and/or a surgical procedure in the peritoneal cavity can be conducted via the wall of the digestive tract with the use of a flexible endoscope. As presently proposed, the technique is particularly adapted to transgastric peritoneoscopy. However, access in addition or in the alternative through the intestinal wall is contemplated and described as well. Transgastric and/or transintestinal peritoneoscopy will have an excellent cosmetic result as there are no incisions in the abdominal wall and no potential for visible post-surgical scars or hernias.

Abstract: Abdominal surgery has traditionally been performed through large incisions into the peritoneal cavity. In the past decade, traditional open surgery has been increasingly replaced by minimally invasive laparoscopic and robotic techniques. In comparison to open surgery, these approaches can decrease postoperative pain, shorten the convalescence period, and improve cosmesis. Nonetheless, these techniques require multiple small entry incisions and are therefore associated with risk of wound infection and incisional hernia. The latest surgical advance is performance of procedures via natural body openings such as the mouth, anus, vagina, and bladder. To date, clinical experience with natural orifice translumenal endoscopic surgery (NOTES) is extremely limited. Herein, we describe the initial clinical case in which we evaluated the bladder as a portal for NOTES. Our experience indicates clinical feasibility of transvesical peritoneoscopy with existing clinical equipment, but additional refinements of the technique and associated instrumentation appear warranted. In comparison to other portals, the urinary tract seems to have distinct clinical advantages for NOTES.

Abstract: Background Recently there has been an increasing enthusiasm for using natural orifices translumenal endoscopic surgery (NOTES) to perform scarless abdominal procedures. We have previously reported the feasibility and safety of the transvesical endoscopic peritoneoscopy in a long-term survival porcine model as useful for those purposes. Herein, we report our successful experience performing transvesical and transdiaphragmatic endoscopic approach to the thoracic cavity in a long-term survival study in a porcine model.