Document Detail


A reliable method for monitoring intraabdominal pressure during natural orifice translumenal endoscopic surgery.
MedLine Citation:
PMID:  17285385     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Natural orifice translumenal endoscopic surgery (NOTES) provides surgical access to the peritoneal cavity without skin incisions. The NOTES procedure requires pneumoperitoneum for visualization and manipulation of abdominal organs, similar to laparoscopy. Accurate measurement of the pneumoperitoneum pressure is essential to avoid potentially deleterious effects of intraabdominal compartment syndrome. A reliable method for monitoring pneumoperitoneum pressures during NOTES has not been identified. This study evaluated several methods of monitoring intraabdominal pressures with a standard gastroscope during NOTES. METHODS: Four female pigs (25 kg) were sedated, and a single-channel gastroscope was passed transgastrically into the peritoneal cavity. Pneumoperitoneum was achieved via a pressure insufflator through a percutaneous, intraperitoneal 14-gauge catheter. Three other pressures were recorded via separate catheters. First, a 14-gauge percutaneous catheter passed intraperitoneally measured true intraabdominal pressure. Second, a 14-gauge tube attached to the endoscope was used to measure endoscope tip pressure. The third pressure transducer was connected directly to the accessory channel of the endoscope. The abdomen was insufflated to a range of pressures (10-30 mmHg), and simultaneous pressures were recorded from all three pressure sensors. RESULTS: Pressure correlation curves were developed for all animals across all intraperitoneal pressures (mean error, -4.25 to -1 mmHg). Endoscope tip pressures correlated with biopsy channel pressures (R2 = 0.99). Biopsy channel and endoscope tip pressures fit a least-squares linear model to predict actual intraabdominal pressure (R = 0.99 for both). Both scope tip and biopsy channel port pressures were strongly correlative with true intraabdominal pressures (R2 = 0.98 and R2 = 0.99, respectively). CONCLUSION: This study demonstrates that monitoring pressure through an endoscope is reliable and predictive of true intraabdominal pressure. Gastroscope pressure monitoring is a useful adjunct to NOTES. Future NOTES procedures should incorporate continuous intraabdominal pressure monitoring to avoid the potentially deleterious effects of pneumoperitoneum during NOTES. This can be achieved by the integration of pressure-monitoring capabilities into gastroscopes.
Authors:
M F McGee; M J Rosen; J Marks; A Chak; R Onders; A Faulx; A Ignagni; S Schomisch; J Ponsky
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Publication Detail:
Type:  Journal Article     Date:  2007-02-07
Journal Detail:
Title:  Surgical endoscopy     Volume:  21     ISSN:  1432-2218     ISO Abbreviation:  Surg Endosc     Publication Date:  2007 Apr 
Date Detail:
Created Date:  2007-03-16     Completed Date:  2007-04-12     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8806653     Medline TA:  Surg Endosc     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  672-6     Citation Subset:  IM    
Affiliation:
Department of Surgery, Case Western Reserve University, Case Medical Center, 11100 Euclid Avenue, Cleveland, OH 44106, USA.
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MeSH Terms
Descriptor/Qualifier:
Abdominal Cavity / physiopathology
Animals
Disease Models, Animal
Endoscopy / methods*
Female
Gastroscopes*
Monitoring, Intraoperative / instrumentation*,  methods
Pneumoperitoneum, Artificial
Sensitivity and Specificity
Swine
Transducers, Pressure

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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