Randomized, blinded comparison of transgastric, transcolonic, and laparoscopic peritoneoscopy for the detection of peritoneal metastases in a human cadaver model - 24/08/11
Reprint requests: Paul Fockens, MD, PhD, Department of Gastroenterology and Hepatology, Academic Medical Center, PO Box 22700, 1100 DE Amsterdam, The NetherlandsRésumé |
Background |
Natural orifice transluminal endoscopic surgery peritoneoscopy may be able to replace laparoscopic peritoneoscopy (LAP) for staging of GI malignancies if it is proven to be equally accurate and safe.
Objective |
To compare transgastric peritoneoscopy (TGP) and transcolonic peritoneoscopy (TCP) to LAP, pairwise, in a randomized, blinded (to location and number of beads) human cadaver model with simulated peritoneal metastases.
Design |
Metastases were simulated by 2.5-mm, color-coded beads, which were placed into the peritoneal cavity via an open approach. In previous porcine experiments, LAP resulted in a yield of 95%. By using a noninferiority design with a margin of equivalence of 15%, we needed a sample size of 34 beads for 80% power. Randomization was performed for number and location of beads. Eighteen experiments were performed on 6 fresh-frozen human cadavers.
Setting |
Experimental surgical laboratory.
Intervention |
LAP, TGP, and TCP were performed in randomized order by one of two surgeons/endoscopists blinded for location and number of beads.
Main Outcome Measurements |
Number of beads detected and touched.
Results |
LAP found and touched 33 beads (yield 97%), TGP 26 beads (76%; difference in yield vs LAP was −20.5 [95% CI, −26.3 to −9.27]), and TCP 29 beads (85%; difference in yield vs LAP was −11.8 [95% CI, −14.6 to 4.98]). Beads that were missed were mostly located at the inferior liver surface: TGP missed 6 of 9 of these beads (67%), TCP 4 of 9 (44%).
Limitations |
Cadaver model.
Conclusion |
In this prospective, blinded, comparative trial in a human cadaver model, TCP was comparable to LAP in detecting simulated metastases. TGP was inferior to LAP. Future development should focus on improved visualization of the inferior surface of the liver.
Le texte complet de cet article est disponible en PDF.Abbreviations : LAP, NOTES, TCP, TGP
Plan
| DISCLOSURE: P. Fockens disclosed receipt of research support from Olympus Medical Systems. Olympus Corporation and Storz Endoskope supplied laparoscopic and endoscopic hardware. The other authors disclosed no financial relationships relevant to this publication. |
|
| If you would like to chat with an author of this article, you may contact Dr Fockens at p.fockens@amc.nl. |
Vol 72 - N° 5
P. 1027-1033 - novembre 2010 Retour au numéro
Article précédent
- Clip closure versus endoscopic suturing versus thoracoscopic repair of an iatrogenic esophageal perforation: a randomized, comparative, long-term survival study in a porcine model (with videos)
- Annette Fritscher-Ravens, Jochen Hampe, Phillippe Grange, Christopher Holland, Femi Olagbeye, Peter Milla, Axel von Herbay, Bjoern Jacobsen, Frauke Seehusen, Klaus-Gerd Hadeler, Kesava Mannur
- Natural orifice transluminal endoscopic surgery: looking beyond the gallbladder
- Jeffrey M. Marks
Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.
Déjà abonné à cette revue ?