Transgastric cholecystectomy using a prototype endoscope with 2 deflecting working channels (with video)

Background: Transgastric cholecystectomy has been shown to be feasible in animal models and human case reports but cumbersome with current available instrumentation. Objective: To evaluate a prototype endoscope with 2 working channels with deflectors at the distal tip for performance of transgastric cholecystectomy. Design: Animal study, nonsurvival and survival. Animals: Sixteen male pigs. Setting: University hospital. Intervention: Transgastric cholecystectomy in 6 nonsurvival pigs by using several different dual-channel endoscopes and 10 survival pigs by using the Olympus dual-channel endoscope with an up-down deflecting channel to the left of the objective lens and a left-right deflecting channel located below the lens. Gallbladder fundic retraction was performed with the aid of one laparoscopic grasper. Results: Cholecystectomy was successful in all survival animals. Median procedure time was 81 minutes (range 31-163 minutes), with a decrease over time. Visualization of all Structures was achieved, and clipping of the cystic duct and artery was successful in all cases. Dissection of the gallbladder via the left-right channel was enhanced with retraction via the Up-clown deflecting channel. Nine of 10 animals survived without complications. One animal died, on postoperative clay 2, secondary to peritonitis due to a leak from the gastrotomy site. Conclusions: This endoscope, with deflecting working channels, allows transgastric cholecystectomy in pigs. The endoscope was stable enough to be used Without an overtube and facilitated retraction and dissection.. This endoscope is promising for use in transgastric cholecystectomy in human beings. (Gastrointest Endosc 2009;69:297-302.)