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Third-generation cholecystectomy by natural orifices: transgastric and transvesical combined approach

2007Journal article Open access
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dc.contributor.authorRolanda, C
dc.contributor.authorLima, E
dc.contributor.authorPêgo, JM
dc.contributor.authorHenriques-Coelho, T
dc.contributor.authorSilva, D
dc.contributor.authorMoreira, I
dc.contributor.authorMacedo, G
dc.contributor.authorCarvalho, JL
dc.contributor.authorCorreia-Pinto, J
dc.date.accessioned2013-12-13T11:26:47Z
dc.date.available2013-12-13T11:26:47Z
dc.date.issued2007
dc.description.abstractBACKGROUND: An isolated transgastric port has some limitations in performing transluminal endoscopic cholecystectomy. However, transvesical access to the peritoneal cavity has recently been reported to be feasible and safe. OBJECTIVE: To assess the feasibility and the technical benefits of transgastric and transvesical combined approach to overcome the limitations of isolated transgastric ports. DESIGN: We created a transgastric and transvesical combined approach to perform cholecystectomy in 7 consecutive anesthetized female pigs. The transgastric access was achieved after perforation and dilation of the gastric wall with a needle knife and with a balloon, respectively. Under cystoscopic control, an ureteral catheter, a guidewire, and a dilator of the ureteral sheath were used to place a transvesical 5-mm overtube into the peritoneal cavity. By using a gastroscope positioned transgastrically and a ureteroscope positioned transvesically, we carried out cholecystectomy in all animals. RESULTS: Establishment of transvesical and transgastric accesses took place without complications. Under a carbon dioxide pneumoperitoneum controlled by the transvesical port, gallbladder identification, cystic duct, and artery exposure were easily achieved in all cases. Transvesical gallbladder grasping and manipulation proved to be particularly valuable to enhance gastroscope-guided dissection. With the exclusion of 2 cases where mild liver-surface hemorrhage and bile leak secondary to the sliding of cystic clips occurred, all remaining cholecystectomies were carried out without incidents. LIMITATIONS: Once closure of the gastric hole proved to be unreliable when using endoclips, the animals were euthanized; necropsy was performed immediately after the surgical procedure. CONCLUSIONS: A transgastric and transvesical combined approach is feasible, and it was particularly useful to perform a cholecystectomy through exclusive natural orifices.por
dc.identifier.citationGastrointest Endosc. 2007;65(1):111-7.por
dc.identifier.urihttp://hdl.handle.net/10400.23/557
dc.language.isoengpor
dc.peerreviewedyespor
dc.publisherElsevierpor
dc.subjectColecistectomiapor
dc.subjectPorcopor
dc.titleThird-generation cholecystectomy by natural orifices: transgastric and transvesical combined approachpor
dc.typejournal article
dspace.entity.typePublication
rcaap.rightsopenAccesspor
rcaap.typearticlepor

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