Transgastric cholecystectomy using a prototype endoscope with 2 deflecting working channels (with video)

Area of Science:

• Minimally Invasive Surgery
• Gastroenterology
• Surgical Instrumentation

Background:

• Transgastric cholecystectomy (gallbladder removal) is feasible but technically challenging with current instruments.
• Existing instrumentation limits the practicality of transgastric approaches.

Purpose of the Study:

• To evaluate a prototype endoscope designed for transgastric cholecystectomy.
• The endoscope features two working channels with distal tip deflectors.

Main Methods:

• A study involving sixteen male pigs (six nonsurvival, ten survival).
• Transgastric cholecystectomy was performed using a dual-channel Olympus endoscope with deflecting channels.
• Gallbladder retraction was assisted by a laparoscopic grasper.

Main Results:

• Successful cholecystectomy was achieved in all ten survival pigs.
• Median procedure time was 81 minutes, decreasing with experience.
• Excellent visualization, successful clipping of cystic duct/artery, and enhanced dissection were noted.
• Nine of ten animals survived without complications; one died from peritonitis.

Conclusions:

• The prototype endoscope with deflecting working channels facilitates transgastric cholecystectomy in pigs.
• The endoscope proved stable, eliminating the need for an overtube and aiding retraction/dissection.
• This technology holds significant promise for human transgastric cholecystectomy procedures.