Gastroscope-assisted Trans-Trocar Gastrostomy and Abdominal Exploration

Summary

Here, we introduce a novel technique of gastrostomy, which integrates laparoscopic and gastroscopic techniques, offering a streamlined approach with reduced invasiveness, expedited recovery, and the capacity for abdominal exploration while minimizing the risk of adjacent organ injury.

Abstract

Advanced endoscopic technologies have revolutionized gastrointestinal surgical procedures, transitioning from open or laparoscopic methods to endoscopic interventions. Gastrostomy is a classic clinical technique for patients with swallowing impediments due to obstructions in the cardiac or esophageal regions and has evolved significantly with the establishment of percutaneous endoscopic gastrostomy (PEG). While PEG offers reduced trauma and swift recovery, it falls short of exploratory capabilities and risks damaging adjacent organs. Therefore, we developed an innovative approach-gastroscope-assisted trans-Trocar gastrostomy (GTTG), which not only takes full play to the advantages of PEG with less trauma and faster postoperative recovery but also takes into account the advantages of laparoscopic gastrostomy with a good exploration of the abdominal cavity. This technique is characterized by ease of operation, minimal trauma (including short operation time and no redundant incision), rapid recovery, the ability to explore the abdominal cavity, and avoidance of injury to adjacent organs, which is quite worthy of widespread promotion in clinical settings.

Introduction

Gastrostomy is the cornerstone of enteral nutrition for patients with organic or functional obstruction of the cardiac orifice or other organs¹. Percutaneous endoscopic gastrostomy (PEG) was first performed in 1979, and it is now a widely accepted and practiced approach². A PEG tube not only functions as a conduit for the administration of liquid nutritional supplements directly into the stomach but also holds utility in the realms of gastric decompression and the management of gastric volvulus, which offers a multifaceted approach to gastrointestinal care³. PEG is a minimally invasive approach co....

Protocol

Ethical approval for the surgical procedure was granted by the ethics board at the First Affiliated Hospital, Sun Yat-Sen University. A 65-year-old male patient, presenting with a one-month history of dysphagia and a diagnosis of esophageal carcinoma with extensive lymph node metastases, was deemed a candidate for systemic therapy following multidisciplinary team discussions. Given the tumor-induced obstruction, gastrostomy was planned to facilitate enteral nutrition, and the patient provided informed consent before the procedure.

1. Surgical procedures

1. Place the patient in a supine position after general anesth....

Discussion

Gastrostomy is a classic therapy for patients without the ability to undergo it because of the organic or functional obstruction of the digestive tract above the cardia. With the development of medicine, laparotomy and laparoscopy have gradually been replaced by PEG, which was first performed in 1979⁷. However, in cases of severe obstruction, endoscopy access may be impeded, prompting the development of Push-PEG and radiologic gastrostomy (RG) to address these challenges⁸

Materials

Name	Company	Catalog Number	Comments
2-0 absorbable suture	Ethicon	VCP345H
Curved forceps
Electric knife pen	Xinhai Hexing Science and technology (dalian) co.,LTD
Gastroscope	Olympics	GIF-H290Z
Percutaneous gastroscopy kit	CREATE MEDIC	PEG18
Rat tooth forceps	Micro-Tech(Nanjing)	MTN-GF-23
Scissors
Trocar	Surgaid Medical	12mm
Vessel forceps