Comparison of transcolonic NOTES and laparoscopic peritoneoscopy for the detection of peritoneal metastases

R. P. Voermans, Douglas Orrick Faigel, M. I. Van Berge Henegouwen, B. Sheppard, P. Fockens

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Background and aims: Peritoneoscopy by natural orifice transluminal endoscopic surgery (NOTES) could replace laparoscopic staging peritoneoscopy (LAP) if the yield were comparable to that from LAP. In previously performed porcine experiments, transgastric peritoneoscopy seemed inferior to LAP due to limited visualization of the liver. The aim of the present study was to improve liver visualization by using a colonic approach and to compare transcolonic peritoneoscopy (TCP) with the previously set LAP standard. Methods: Small beads were stapled into porcine peritoneal cavities to simulate metastases. Previously in the same model LAP had detected 95% of beads (95% CI 87%-98%). Using a non inferiority design, a sample size of 33 beads was determined; these were distributed among six animals with randomization for numbers and location. TCP was performed using either standard endoscopic accessories (TCP-s) or a specially designed toolkit (TCP-t) in randomized order by one of two blinded endoscopists. Primary outcome was number of beads found and touched during peritoneoscopy. Results: Locations of beads included abdominal peritoneum (6 beads), diaphragm (8), liver (18), and miscellaneous sites (1). TCP-s found 25 beads (yield 76%, 95% CI 59%-87%). TCP-t found 19 beads (yield 58%, 95% CI 41%-71%). The majority of missed beads were located at the inferior liver surface: TCP-s detected 8/15 (53%) and TCP-t 5/15 (33%) of these simulated metastases. Conclusions: In this prospective, experimental trial, transcolonic NOTES peritoneoscopy was inferior in comparison with the diagnostic laparoscopy done previously in the same model.

Original languageEnglish (US)
Pages (from-to)904-909
Number of pages6
JournalEndoscopy
Volume42
Issue number11
DOIs
StatePublished - 2010
Externally publishedYes

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Natural Orifice Endoscopic Surgery
Laparoscopy
Neoplasm Metastasis
Liver
Swine

ASJC Scopus subject areas

  • Gastroenterology

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Comparison of transcolonic NOTES and laparoscopic peritoneoscopy for the detection of peritoneal metastases. / Voermans, R. P.; Faigel, Douglas Orrick; Van Berge Henegouwen, M. I.; Sheppard, B.; Fockens, P.

In: Endoscopy, Vol. 42, No. 11, 2010, p. 904-909.

Research output: Contribution to journalArticle

Voermans, R. P. ; Faigel, Douglas Orrick ; Van Berge Henegouwen, M. I. ; Sheppard, B. ; Fockens, P. / Comparison of transcolonic NOTES and laparoscopic peritoneoscopy for the detection of peritoneal metastases. In: Endoscopy. 2010 ; Vol. 42, No. 11. pp. 904-909.
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abstract = "Background and aims: Peritoneoscopy by natural orifice transluminal endoscopic surgery (NOTES) could replace laparoscopic staging peritoneoscopy (LAP) if the yield were comparable to that from LAP. In previously performed porcine experiments, transgastric peritoneoscopy seemed inferior to LAP due to limited visualization of the liver. The aim of the present study was to improve liver visualization by using a colonic approach and to compare transcolonic peritoneoscopy (TCP) with the previously set LAP standard. Methods: Small beads were stapled into porcine peritoneal cavities to simulate metastases. Previously in the same model LAP had detected 95{\%} of beads (95{\%} CI 87{\%}-98{\%}). Using a non inferiority design, a sample size of 33 beads was determined; these were distributed among six animals with randomization for numbers and location. TCP was performed using either standard endoscopic accessories (TCP-s) or a specially designed toolkit (TCP-t) in randomized order by one of two blinded endoscopists. Primary outcome was number of beads found and touched during peritoneoscopy. Results: Locations of beads included abdominal peritoneum (6 beads), diaphragm (8), liver (18), and miscellaneous sites (1). TCP-s found 25 beads (yield 76{\%}, 95{\%} CI 59{\%}-87{\%}). TCP-t found 19 beads (yield 58{\%}, 95{\%} CI 41{\%}-71{\%}). The majority of missed beads were located at the inferior liver surface: TCP-s detected 8/15 (53{\%}) and TCP-t 5/15 (33{\%}) of these simulated metastases. Conclusions: In this prospective, experimental trial, transcolonic NOTES peritoneoscopy was inferior in comparison with the diagnostic laparoscopy done previously in the same model.",
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N2 - Background and aims: Peritoneoscopy by natural orifice transluminal endoscopic surgery (NOTES) could replace laparoscopic staging peritoneoscopy (LAP) if the yield were comparable to that from LAP. In previously performed porcine experiments, transgastric peritoneoscopy seemed inferior to LAP due to limited visualization of the liver. The aim of the present study was to improve liver visualization by using a colonic approach and to compare transcolonic peritoneoscopy (TCP) with the previously set LAP standard. Methods: Small beads were stapled into porcine peritoneal cavities to simulate metastases. Previously in the same model LAP had detected 95% of beads (95% CI 87%-98%). Using a non inferiority design, a sample size of 33 beads was determined; these were distributed among six animals with randomization for numbers and location. TCP was performed using either standard endoscopic accessories (TCP-s) or a specially designed toolkit (TCP-t) in randomized order by one of two blinded endoscopists. Primary outcome was number of beads found and touched during peritoneoscopy. Results: Locations of beads included abdominal peritoneum (6 beads), diaphragm (8), liver (18), and miscellaneous sites (1). TCP-s found 25 beads (yield 76%, 95% CI 59%-87%). TCP-t found 19 beads (yield 58%, 95% CI 41%-71%). The majority of missed beads were located at the inferior liver surface: TCP-s detected 8/15 (53%) and TCP-t 5/15 (33%) of these simulated metastases. Conclusions: In this prospective, experimental trial, transcolonic NOTES peritoneoscopy was inferior in comparison with the diagnostic laparoscopy done previously in the same model.

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