Endoscopic gastric vagotomy: a feasibility study using laser in dogs

Area of Science:

• Gastroenterology
• Surgical Innovation
• Laser Technology

Background:

• Vagotomy is a surgical procedure involving cutting the vagus nerve to reduce stomach acid production.
• Endoscopic approaches offer potential minimally invasive alternatives to traditional surgery.
• The neodymium:yttrium-aluminum-garnet (Nd:YAG) laser presents a tool for precise tissue ablation.

Purpose of the Study:

• To assess the feasibility of endoscopic gastric vagotomy using the Nd:YAG laser in a canine model.
• To define target anatomical zones for endoscopic vagotomy based on gross and histological findings.
• To evaluate the safety and efficacy of this endoscopic approach.

Main Methods:

• Gross and histological examination of canine stomachs to identify vagal nerve branch locations.
• Endoscopic laser application targeting specific mucosal landmarks.
• Dosimetric control of the Nd:YAG laser energy for tissue injury.
• Monitoring for complications such as perforation.

Main Results:

• Defined target zones for vagotomy were identified along the lesser curvature, accessible endoscopically.
• Achieving sufficient thermal injury to transect deep vagal branches required nearly full-thickness burns.
• Delayed perforations occurred in three out of four dogs, indicating a lack of precise thermal control.
• The Nd:YAG laser's thermal penetration depth proved difficult to manage in this model.

Conclusions:

• Endoscopic gastric vagotomy using the Nd:YAG laser is not currently feasible in dogs due to uncontrolled thermal injury depth.
• The predictable location and accessibility of target vagal branches make the endoscopic concept appealing.
• Further research is needed to refine laser dosimetry or explore alternative endoscopic methods for vagotomy.