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. 2008 Jan-Mar;12(1):30-6.

Laparoscopic-assisted transgastric endoscopy: current indications and future implications

Kurt E Roberts  1 , Lucian Panait, Andrew J Duffy, Priya A Jamidar, Robert L Bell
Affiliations

Laparoscopic-assisted transgastric endoscopy: current indications and future implications

Kurt E Roberts et al. JSLS. 2008 Jan-Mar.

Abstract

Background: Endoscopic access to the proximal gastrointestinal tract may prove difficult for a variety of anatomic reasons. Under laparoscopic visualization, trocars can be placed into the stomach with the subsequent introduction of a flexible endoscope directly into the body of the stomach. The purpose of this study was to describe this technique and demonstrate that it is safe, effective, and feasible.

Methods: Six patients with altered proximal foregut anatomy were examined. Five patients had previously undergone laparoscopic Roux-Y gastric bypass, and one patient had severe distal esophageal stenosis precluding distal passage of an endoscope. All patients required endoscopic retrograde cholangiopancreatography (ERCP), and one patient underwent closure of a symptomatic gastrogastric fistula. In each patient, two 5-mm ports were inserted and tacking sutures placed between the gastric body and the anterior abdominal wall. Subsequently, a flexible endoscope was inserted into the stomach through a gastrotomy under direct visualization. Picture-in-picture technology enabled simultaneous monitoring of the laparoscopic and endoscopic field.

Results: The operative time ranged from 64 minutes to 93 minutes. All therapeutic endoscopic procedures were successful. The anterior gastrotomies were either closed primarily or a feeding tube was placed. Patients reported minimal postoperative pain. No complications resulted from the procedures.

Conclusion: In an age where surgeons and gastroenterologists are focusing on the stomach as an access point for transgastric endoscopic surgery, we view the stomach as a portal into the gastrointestinal tract. In patients with limited access for traditional endoluminal therapy, laparoscopic-assisted transgastric endoscopy can be performed safely and efficiently.

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Figures

Figure 1.
Figure 1.
Laparoscopic port placement.
Figure 2.
Figure 2.
Stomach is being pulled up to the anterior abdominal wall.
Figure 3.
Figure 3.
Endoscope is being advanced into stomach.
Figure 4.
Figure 4.
Closure of gastrotomy.
See this image and copyright information in PMC

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