Reliability of gastric access closure with the self-approximating transluminal access technique (STAT) for NOTES

• Published in: Surgical endoscopy Vol. 25; no. 8; pp. 2718 - 2724
• Main Authors: Mathew, Abraham, Tomasko, Jonathan M., Pauli, Eric M., Moyer, Matthew T., Gopal, Jegan, Ancrile, Brooke B., Rogers, Ann M., Haluck, Randy S.
• Format: Journal Article
• Language: English
• Published: New York Springer-Verlag 01-08-2011; Springer; Springer Nature B.V
• Subjects: Abdominal Surgery; Animals; Biological and medical sciences; Dissection; Endoluminal Surgery; Endoscopy; Esophagus; Gastroenterology; Gynecology; Hepatology; Laparoscopy; Liver, biliary tract, pancreas, portal circulation, spleen; Medical sciences; Medicine; Medicine & Public Health; Natural Orifice Endoscopic Surgery - methods; Ostomy; Proctology; Stomach; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Swine; United States > US; Cholecystectomy; Training; STAT; Endoscopy; Self-approximating transluminal access technique; Endoscopic surgery; Stomach; Treatment; Digestive system; Gallbladder; Technique
• ISSN: 0930-2794; 1432-2218
• DOI: 10.1007/s00464-011-1659-4

Background
STAT, or the self-approximating transluminal access technique, has been previously described and involves the dissection of a submucosal tunnel for peritoneal or mediastinal access from the esophagus and stomach. The objective of this study was to assess the safety and reliability of gastric access and closure in a porcine experience using STAT for natural orifice transluminal endoscopic surgery (NOTES).
Methods
A review of the experience using STAT access tunnels for intraperitoneal access was performed in 39 female pigs at a university animal lab. All animals underwent a predetermined NOTES surgical procedure using a STAT transgastric access tunnel based on a specific protocol. Details of the procedure, complications, and clinical course were documented. Necropsy was performed at 2 weeks. The main outcome measurements were clinical or necropsy evidence of gastrostomy site leak or inadequate access site closure.
Results
STAT was successful in providing safe peritoneal access in all animals. The width of the tunnel ranged from 1.5 to 5.5 cm and the length was up to 27 cm. There was no evidence of gastrostomy site leak in any animals. One animal required a single laparoscopic suture to help with tunnel closure.
Conclusion
STAT provides safe transgastric access and allows secure closure of the gastrotomy site.