Transgastric access by balloon overtube for intraperitoneal surgery

Area of Science:

• Gastroenterology
• Surgical Innovation
• Minimally Invasive Procedures

Background:

• The peritoneal cavity is the next frontier for endoscopy, with Natural Orifice Transluminal Endoscopic Surgery (NOTES) enabling access.
• Endoscopic perforation during NOTES presents a significant challenge due to the risk of peritonitis and associated complications.

Purpose of the Study:

• To describe a novel overtube system for accessing the peritoneal cavity via NOTES.
• To evaluate the system's ability to facilitate controlled gastric perforation and safe closure in a canine model.

Main Methods:

• A canine model was used to test an overtube system designed for NOTES procedures.
• The system, featuring a balloon overtube, was employed to access the peritoneal cavity directly from the mouth.
• Methods focused on performing a controlled perforation and ensuring safe closure of the gastric wall.

Main Results:

• The overtube system successfully provided direct access to the peritoneal cavity through the mouth.
• The system facilitated a controlled gastric perforation.
• Conditions were established for the safe closure of the gastric wall following perforation.

Conclusions:

• The described overtube system offers a viable approach for peritoneal cavity access using NOTES.
• This method allows for controlled perforation and safe closure, addressing key safety concerns in NOTES procedures.
• The canine model demonstrated the potential of this system to advance NOTES capabilities.