Objectives: Standard laparoscopy requires general anesthesia for muscle paralysis to allow for adequate pneumoperitoneum. Our goal is to determine the effectiveness of diagnostic peritoneoscopy using a flexible endoscope under low pressure pneumoperitoneum.
Methods: Three 25-kg female swine were subjected to general anesthesia. Pneumoperitoneum to 8mm Hg was achieved with a veress needle. Using a laparoscopic tacking device, 4 tacks were place on the peritoneum in random locations. A separate surgical team that was not present during placement of the tacks then introduced a 2 channel, Storz gastroscope through a periumbilical incision. The team was asked to localize the tacks using the flexible endoscope.
Results: Average time for complete exploration and detection of 4 tacks was 30 ± 10 minutes. Two different surgeons with varying degrees of expertise with flexible endoscopy were able to detect all the tacks in 3 pigs with a sensitivity of 100%. The subdiaphragmatic area was visualized in all the cases.
Conclusion: Transabdominal diagnostic peritoneoscopy using the flexible endoscope under low pressure pneumoperitoneum is feasible. Potential benefits may allow us to perform diagnostic peritoneoscopy without the need for general anesthesia and muscle paralysis in an office or urgent care setting.
Program Number: P381