And fluid leak tests after NOTES procedures: a pilot study in a live porcine model (with videos)

作者：Dray Xavier; Gabrielson Kathleen L; Buscaglia Jonathan M; Shin Eun Ji; Giday Samuel A; Surti Vihar C; Assumpcao Lia; Marohn Michael R; Magno Priscilla; Pipitone Laurie J; Redding Susan K; Kalloo Anthony N; Kantsevoy Sergey V^*

来源：Gastrointestinal Endoscopy, 2008, 68(3): 513-519.

DOI：10.1016/j.gie.2007.12.052

Background: Transluminal access site closure remains a major challenge in natural orifice transluminal endoscopic Surgery (NOTES).
Objective: Our purpose Was to develop in vivo leak tests for evaluation of the integrity of transgastric access closure.
Settings: Survival experiments on 12 50-kg pigs.
Design and Interventions: After a standardized transgastric approach to the peritoneal cavity and peritoneoscopy the gastric wall incision was closed with T-bars (Wilson-Cook Medical, Winston-Salem, NC) deployed on both sides of the incision and then cinched together. Gastrotomy closure was assessed with air and fluid leak tests. The animals were observed for 1 week and then underwent endoscopic evaluation and necropsy.
Main Outcome Measurements: (1) Leak-proof closure of the gastric wall incision. (2) Gastric incision healing 1 week after the procedure.
Results: The mean intraperitoneal pressure increased 10.7 +/- 3.7 mm Hg during gastric insufflation when the air leak test was performed before closure compared with 0.9 +/- 0.8 mm Hg after transmural closure of the transgastric access site with T-bars (P <.001). Fluid leak tests demonstrated no leakage of liquid contrast from the stomach into the peritoneal cavity after closure. Necropsy in 1 week confirmed completeness of the gastric closure in all animals with full-thickness healing and no spillage of the gastric contents into the peritoneal cavity.
Limitations: Leak tests were only evaluated oil an animal model.
Conclusions: Fluid and air leak tests are simple techniques to evaluate in vivo the adequacy of the transluminal access site closure after NOTES procedures. Leak-proof gastric closure resulted in adequate tissue approximation and full-thickness healing of the gastric wall incision.

• 出版日期2008-9