Portal de Periódicos da CAPES

Per-Oral Transgastric Endoscopic Ligation of Fallopian Tubes with Long-Term Survival in a Porcine Model

2004; Elsevier BV; Volume: 59; Issue: 5 Linguagem: Inglês

10.1016/s0016-5107(04)00551-6

1097-6779

Sergey V. Kantsevoy, Sanjay Jagannath, Cheryl A. Vaughn, Diana G. Scorpio, Carolyn Magee, Laurie Pipitone, Anthony N. Kalloo, Apollo Apollo Group,

Gastrointestinal Tumor Research and Treatment

Background: We have previously reported the feasibility and safety of the per-oral transgastric endoscopic approach for diagnostic peritoneoscopy, liver biopsy, and gastrojejunostomy with long-term survival in a porcine model. This approach eliminates incisions of abdominal wall, providing a less-invasive alternative to diagnostic and therapeutic laparoscopy. We now report successful performance of per-oral endoscopic transgastric ligation of Fallopian tubes with long-term survival in a porcine model. Methods: Five female 50Kg pigs had general anesthesia and irrigation of the stomach with an antibiotic solution. Gastric puncture was performed with needle-knife electrocautery followed by balloon dilatation of the tract with 20-mm TTS dilating balloon (Microvasive®). A standard upper endoscope that underwent high-level disinfection and gas sterilzation was advanced into the peritoneal cavity through a sterile overtube. Both Fallopian tubes were identified and one was ligated using Olympus® Endoloops. The other patent tube served as a control. Tubal patency was evaluated by hysterosalpingogram before and after ligation. All pigs were survived for 2-3 weeks, and then sacrificed for postmortem examination. Results: The Fallopian tubes were easily accessed, identified and ligated in all 5 pigs. In each pig, fluoroscopy confirmed complete obstruction of ligated tube with preserved patency of the other tube. All pigs survived well, ate heartily without any ill-effects. Postmortem examination did not reveal any peritonitis or intraabdominal adhesions. The Endoloops® were in place with complete obstruction of the ligated tubes and patency of the controls. Histopathologic examination of the tubes showed chronic inflammatory infiltrates without abscesses. Conclusion: The per-oral endoscopic transgastric approach to ligation of the Fallopian tubes with long-term survival is technically feasible and safe. The endoscopic transgastric approach to the peritoneal cavity has potential for a wide array of diagnostic and therapeutic procedures.