Endoscopic Transgastric Oophorectomy and Tubectomy: Survival Studies in a Porcine Model

Abstract

Introduction: The development of newer endoscopic devices has enabled transgastric abdominal exploration but there are no published reports of transgastric organ resection. The aim of this study was to test the feasibility of endoscopic oophorectomy and tubectomy using the per-oral transgastric technique. Methods: Female pigs weighing 25-30 kg were kept NPO for 48 hours prior to surgery. Under general anesthesia a sterile overtube was placed into the esophagus, over a single-channel gastroscope. Antibacterial gastric lavage was performed with Cefazolin. A second sterile therapeutic gastroscope was passed through the overtube. Subsequently, a transgastric incision was made with a needle-knife and dilated with a balloon, if required. The endoscope was then introduced into the peritoneal cavity and the ovary and fallopian tube were identified. An Endoloop was used to secure the ovary and fallopian tube with the mesosalpinx. Snare cautery was then used to perform oophorectomy and tubectomy. The specimen was retrieved by withdrawing the endoscope through the gastrotomy. The gastric incision was then closed with Endoclips. Post-operative medications included: Enrofloxacin; Flunixin and topical Fentanyl patch for analgesia; Ranitidine for acid suppression. Two-week survival studies were performed. Animals were observed daily, and resumed a regular diet starting the morning after surgery. Results: The peritoneal cavity was accessed in all animals (n = 6) without bleeding or damage to surrounding structures. The ovary and fallopian tubes with mesosalpinx were easily identified, and unilateral oophorectomy and tubectomy successfully performed. Postoperative course was uneventful in five animals. The animals did not show any signs of distress, ambulated freely and tolerated a regular diet. One animal developed lethargy and fever postoperatively but promptly responded to antibiotics. Necropsy verified unilateral oophorectomy and tubectomy without evidence of intra-abdominal abscesses, hematomas, damage to surrounding viscera or adhesions. The omentum was found adherent to the serosal aspect of the gastrotomy in two animals. Conclusion: Endoscopic transgastric organ resection (oophorectomy and tubectomy) is technically feasible in a porcine model without early complications. Further studies with newer, more dexterous endoscopic tools are necessary to determine the role of this promising new technique. Introduction: The development of newer endoscopic devices has enabled transgastric abdominal exploration but there are no published reports of transgastric organ resection. The aim of this study was to test the feasibility of endoscopic oophorectomy and tubectomy using the per-oral transgastric technique. Methods: Female pigs weighing 25-30 kg were kept NPO for 48 hours prior to surgery. Under general anesthesia a sterile overtube was placed into the esophagus, over a single-channel gastroscope. Antibacterial gastric lavage was performed with Cefazolin. A second sterile therapeutic gastroscope was passed through the overtube. Subsequently, a transgastric incision was made with a needle-knife and dilated with a balloon, if required. The endoscope was then introduced into the peritoneal cavity and the ovary and fallopian tube were identified. An Endoloop was used to secure the ovary and fallopian tube with the mesosalpinx. Snare cautery was then used to perform oophorectomy and tubectomy. The specimen was retrieved by withdrawing the endoscope through the gastrotomy. The gastric incision was then closed with Endoclips. Post-operative medications included: Enrofloxacin; Flunixin and topical Fentanyl patch for analgesia; Ranitidine for acid suppression. Two-week survival studies were performed. Animals were observed daily, and resumed a regular diet starting the morning after surgery. Results: The peritoneal cavity was accessed in all animals (n = 6) without bleeding or damage to surrounding structures. The ovary and fallopian tubes with mesosalpinx were easily identified, and unilateral oophorectomy and tubectomy successfully performed. Postoperative course was uneventful in five animals. The animals did not show any signs of distress, ambulated freely and tolerated a regular diet. One animal developed lethargy and fever postoperatively but promptly responded to antibiotics. Necropsy verified unilateral oophorectomy and tubectomy without evidence of intra-abdominal abscesses, hematomas, damage to surrounding viscera or adhesions. The omentum was found adherent to the serosal aspect of the gastrotomy in two animals. Conclusion: Endoscopic transgastric organ resection (oophorectomy and tubectomy) is technically feasible in a porcine model without early complications. Further studies with newer, more dexterous endoscopic tools are necessary to determine the role of this promising new technique.