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• W2048663422 abstract "Background: Transgastric surgical techniques using flexible endoscopes have been introduced without monitoring intra-peritoneal pressure or feedback control of inflation, which are standard during conventional rigid laparoscopy. There are no published data on intra-peritoneal pressures during transgastric procedures and surprisingly little data on intragastric pressures during routine gastroscopy. Over-inflation of the peritoneal cavity can reduce diaphragmatic movement, cause impaired ventilation, reduce venous return with consequent fall in blood pressure and cause air embolism. Materials and Methods: Inflation pressure was monitored during a series of transgastric procedures including endoscopic full-thickness resection, transgastric suturing procedures and anastomosis in pigs weighing 28-37 kg. Direct measurements made using a trans-abdominal needle attached to a Storz laparoscope insufflator were compared with those made through a double channel Olympus endoscope. A modified valve was attached to the accessory port of the double channel endoscope which also allowed feed-back control of intraperitoneal pressure by automatic regulation and measurement of the volume of inflated air. Results: Measurements of intragastric pressure during a range of transgastric procedures, peak intraperitoneal pressures above 30 mm Hg were common. These are more than twice as high as those regarded as acceptable for conventional rigid laparoscopy. Overdistension was commonly observed and simply managed usually by needle venting of air through the abdominal wall during these procedures or aspiration through the gastroscope. Adverse effects on blood pressure and pulse rate were observed during some of these procedures. No fatalities or air embolism was observed. A prototype valve connector was tested using a Storz insufflator attached to the valve on a double channel gastroscope. The pressures correlated well with those measured via a transabdominal needle placed directly in the peritoneal cavity using a Verres technique. This technique more than halved the peak pressures measured during transgastric surgical techniques and allowed the use of safe automatic insufflation pressures with flexible endoscopes in the peritoneal cavity as are currently standard during laparoscopy. Conclusions: Direct measurements indicated that over-inflation of the peritoneal cavity was very common during experimental transgastric procedures using flexible endoscopes. A modified valve attached to the accessory port of a gastroscope halved the peak pressures and allowed automatic regulation and monitoring during transgastric surgical procedures." @default.
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• W2048663422 date "2006-04-01" @default.
• W2048663422 modified "2023-09-25" @default.
• W2048663422 title "Measurements of Intraperitoneal Pressure During Flexible Transgastric Surgery and the Development of a Feed-Back Control Valve for Regulating Pressure" @default.
• W2048663422 doi "https://doi.org/10.1016/j.gie.2006.03.099" @default.
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