Laparoscopic sleeve gastrectomy with transgastric visualization: another step toward totally NOTES procedures.

Area of Science:

• Minimally Invasive Surgery
• Bariatric Surgery
• Endoscopic Surgery

Background:

• Laparoendoscopic single-site sleeve gastrectomy is increasingly adopted.
• Totally natural orifice translumenal endoscopic surgery (NOTES) for morbid obesity faces safety and technical challenges.
• A novel technique using transgastric visualization and a transvaginal operating channel for sleeve gastrectomy is proposed.

Purpose of the Study:

• To evaluate a combined transvaginal and transgastric approach for sleeve gastrectomy.
• To simulate a dual-lumen totally NOTES sleeve gastrectomy procedure.
• To advance NOTES techniques for bariatric surgery in obese patients.

Main Methods:

• A combined NOTES and single trocar sleeve gastrectomy was performed on 8 porcine models.
• An endoscope was inserted through the gastric wall for visualization.
• A second endoscope and instruments were introduced via a transabdominal trocar.

Main Results:

• Sleeve gastrectomy was successfully completed in all 8 porcine models.
• Initial operative time of 5 hours was reduced by 50% with technique refinement.
• Excellent surgical field visualization was achieved via the transgastric approach.

Conclusions:

• Combined NOTES and single trocar sleeve gastrectomy is feasible in a porcine model.
• The transgastric approach provides excellent visualization for sleeve gastrectomy.
• Further research will explore combining transgastric visualization with a transvaginal route for total NOTES sleeve gastrectomy.