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Endoscopy 2010; 42(12): 1096-1103
DOI: 10.1055/s-0030-1255824
Original article

© Georg Thieme Verlag KG Stuttgart · New York

The role of a computed tomography-based image registered navigation system for natural orifice transluminal endoscopic surgery: a comparative study in a porcine model

G.  Fernández-Esparrach1 , R.  San José Estépar2 , C.  Guarner-Argente1 , G.  Martínez-Pallí3 , R.  Navarro3 , C.  Rodríguez de Miguel1 , H.  Córdova1 , C.  C.  Thompson4 , A.  M.  Lacy5 , L.  Donoso6 , J.  R.  Ayuso-Colella6 , A.  Ginès1 , M.  Pellisé1 , J.  Llach1 , K.  G.  Vosburgh2 , 7
  • 1Endoscopy Unit, Department of Gastroenterology, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERehd, Barcelona, Spain
  • 2Department of Radiology, Brigham and Women’s Hospital, Boston, USA
  • 3Anesthesiology Department, Hospital Clinic, University of Barcelona, Barcelona, Spain
  • 4Division of Gastroenterology, Brigham and Women’s Hospital, Boston, Massachusetts, USA
  • 5Department of Surgery, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERehd, Barcelona, Spain
  • 6Department of Radiology, Hospital Clinic, University of Barcelona, Barcelona, Spain
  • 7Center for Integration of Medicine and Innovative Technology, USA
Further Information

Publication History

submitted 24 December 2010

accepted after revision 19 July 2010

Publication Date:
19 October 2010 (online)

Also available at
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Background and study aims: Most natural orifice transluminal endoscopic surgery (NOTES) procedures have been performed in animal models through the anterior stomach wall, but this approach does not provide efficient access to all anatomic areas of interest. Moreover, injury of the adjacent structures has been reported when using a blind access. The aim of the current study was to assess the utility of a CT-based (CT: computed tomography) image registered navigation system in identifying safe gastrointestinal access sites for NOTES and identifying intraperitoneal structures.

Methods: A total of 30 access procedures were performed in 30 pigs: anterior gastric wall (n = 10), posterior gastric wall (n = 10), and anterior rectal wall (n = 10). Of these, 15 procedures used image registered guidance (IR-NOTES) and 15 procedures used a blind access (NOTES only). Timed abdominal exploration was performed with identification of 11 organs. The location of the endoscopic tip was tracked using an electromagnetic tracking system and was recorded for each case. Necropsy was performed immediately after the procedure. The primary outcome was the rate of complications; secondary outcome variables were number of organs identified and kinematic measurements.

Results: A total of 30 animals weighting a mean (± SD) of 30.2 ± 6.8 kg were included in the study. The incision point was correctly placed in 11 out of 15 animals in each group (73.3 %). The mean peritoneoscopy time and the number of properly identified organs were equivalent in the two groups. There were eight minor complications (26.7 %), two (13.3 %) in the IR-NOTES group and six (40.0 %) in the NOTES only group (P = n. s.). Characteristics of the endoscope tip path showed a statistically significant improvement in trajectory smoothness of motion for all organs in the IR-NOTES group.

Conclusion: The image registered system appears to be feasible in NOTES procedures and results from this study suggest that image registered guidance might be useful for supporting navigation with an increased smoothness of motion.

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G. Fernández-EsparrachMD, PhD 

Endoscopy Unit
Gastroenterology Department
Hospital Clinic

Villarroel 170
08026 Barcelona
Spain

Fax: +34-93-2279850

Email: mgfernan@clinic.ub.es

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