• Skip to primary navigation
  • Skip to main content
  • Skip to footer

SAGES

Reimagining surgical care for a healthier world

  • Home
    • Search
    • SAGES Home
    • SAGES Foundation Home
  • About
    • Who is SAGES?
    • SAGES Mission Statement
    • Advocacy
    • Strategic Plan, 2020-2023
    • Committees
      • Request to Join a SAGES Committee
      • SAGES Board of Governors
      • Officers and Representatives of the Society
      • Committee Chairs and Co-Chairs
      • Full Committee Rosters
      • SAGES Past Presidents
    • Donate to the SAGES Foundation
    • SAGES Store
    • Awards
      • George Berci Award
      • Pioneer in Surgical Endoscopy
      • Excellence In Clinical Care
      • International Ambassador
      • IRCAD Visiting Fellowship
      • Social Justice and Health Equity
      • Excellence in Community Surgery
      • Distinguished Service
      • Early Career Researcher
      • Researcher in Training
      • Jeff Ponsky Master Educator
      • Excellence in Medical Leadership
      • Barbara Berci Memorial Award
      • Brandeis Scholarship
      • Advocacy Summit
      • RAFT Annual Meeting Abstract Contest and Awards
    • “Unofficial” Logo Products
  • Meetings
    • NBT Innovation Weekend
    • SAGES Annual Meeting
      • 2024 Scientific Session Call For Abstracts
      • 2024 Emerging Technology Call For Abstracts
    • CME Claim Form
    • Industry
      • Advertising Opportunities
    • Future Meetings
    • Related Meetings Calendar
  • Join SAGES!
    • Membership Benefits
    • Membership Applications
      • Active Membership
      • Affiliate Membership
      • Associate Active Membership
      • Candidate Membership
      • International Membership
      • Medical Student Membership
    • Member News
      • Member Spotlight
      • Give the Gift of SAGES Membership
  • Patients
    • Healthy Sooner – Patient Information for Minimally Invasive Surgery
    • Patient Information Brochures
    • Choosing Wisely – An Initiative of the ABIM Foundation
    • All in the Recovery: Colorectal Cancer Alliance
    • Find a SAGES Member
  • Publications
    • SAGES Stories Podcast
    • SAGES Clinical / Practice / Training Guidelines, Statements, and Standards of Practice
    • Patient Information Brochures
    • TAVAC – Technology and Value Assessments
    • Surgical Endoscopy and Other Journal Information
    • SAGES Manuals
    • SCOPE – The SAGES Newsletter
    • COVID-19 Annoucements
    • Troubleshooting Guides
  • Education
    • Wellness Resources – You Are Not Alone
    • OpiVoid.org
    • SAGES.TV Video Library
    • Safe Cholecystectomy Program
      • Safe Cholecystectomy Didactic Modules
    • Masters Program
      • SAGES Facebook Program Collaboratives
      • Acute Care Surgery
      • Bariatric
      • Biliary
      • Colorectal
      • Flexible Endoscopy (upper or lower)
      • Foregut
      • Hernia
      • Robotics
    • Educational Opportunities
    • HPB/Solid Organ Program
    • Courses for Residents
      • Advanced Courses
      • Basic Courses
    • Fellows Career Development Course
    • Robotics Fellows Course
    • MIS Fellows Course
    • Facebook Livestreams
    • Free Webinars For Residents
    • SMART Enhanced Recovery Program
    • SAGES OR SAFETY Video
    • SAGES Top 21 MIS Procedures
    • SAGES Pearls
    • SAGES Flexible Endoscopy 101
    • SAGES Tips & Tricks of the Top 21
  • Opportunities
    • NEW-Area of Concentrated Training Seal (ACT)-Advanced Flexible Endoscopy
    • SAGES Fellowship Certification for Advanced GI MIS and Comprehensive Flexible Endoscopy
    • Multi-Society Foregut Fellowship Certification
    • SAGES Research Opportunities
    • Fundamentals of Laparoscopic Surgery
    • Fundamentals of Endoscopic Surgery
    • Fundamental Use of Surgical Energy
    • Job Board
    • SAGES Go Global: Global Affairs and Humanitarian Efforts
  • Search
    • Search All SAGES Content
    • Search SAGES Guidelines
    • Search the Video Library
    • Search the Image Library
    • Search the Abstracts Archive
  • OWLS
  • Log In

Management of Intraoperative Hemorrhage During NOTES®: A Prospective Randomized Comparison

Byron F Santos, MD, Stephen S Plachta, BS, Nathaniel J Soper, MD, Eric S Hungness, MD. Northwestern University Department of Surgery, Chicago, IL

Introduction: The optimal strategy to manage intraoperative hemorrhage during NOTES is unknown. We performed a randomized comparison of three instruments for hemorrhage control during hybrid transvaginal NOTES: prototype endoscopic bipolar hemostasis forceps (BELA), prototype endoscopic clip (E-CLIP) appliers, or conventional laparoscopic clip (L-CLIP) appliers.

Methods: Transvaginal access was obtained in swine using a dual-channel, flexible gastroscope, under an IACUC-approved protocol. The gastroepiploic (GE) arterio-venous bundle (~3mm vessels) was transected to induce hemorrhage. Hemostasis was attempted using a hybrid NOTES technique (flexible endoscope plus a single umbilical port) with the BELA, E-CLIP, or L-CLIP. Full laparoscopic salvage was performed if hemorrhage control failed after 10 minutes. Hemorrhage was re-induced a total of three times on the GE vessels and also in 1-2mm, distal mesenteric vessels (MV), with each hemostasis attempt utilizing a different instrument in a sequential, randomized fashion. Outcomes included primary success rate (PS), primary hemostasis time (PHT), total number of device applications (DA), and salvage success rate (SS).

Results: A total of 70 hemostasis attempts were made in 12 swine. PS was similar for all techniques on MV (80-100%) but the BELA and L-CLIP resulted in shorter mean PHT compared to E-CLIP. PS was worse on GE vessels (42-67%) compared to MV, with significantly longer PHT and higher DA, but similar performance between techniques. Laparoscopic salvage took an average of 101 ± 41 sec for the MV and 306 ± 125 sec for the GE vessels, regardless of which instrument was used during the initial hemostasis attempt.

Outcomes, by Instrument and Artery (Mean ± SD)
BELA E-CLIP L-CLIP Difference p – value
Primary Success (PS) – % MV 100% 80% 100% None .08
GE 67% 42% 67% None .36
Primary Hemostasis Time (PHT) – sec. MV 203 ± 67 362 ± 93 144 ± 63 BELA, L-CLIP < E-CLIP .001
GE 521 ± 76 445 ± 127 462 ± 143 None NS
Total Device Applications (DA) – no. MV 5 ± 2 3 ± 1 3 ± 1 None NS
GE 12 ± 5 2 ± 1 7 ± 2 BELA > L-CLIP > E-CLIP .002
Salvage Success (SS) – % MV – 100% – – –
GE 100% 100% 100% None NS

Conclusion: All three instruments had similar effectiveness in achieving primary hemostasis during hybrid NOTES. Management of small vessel bleeding (1-2 mm vessels) in a porcine hybrid NOTES model is effective using all three instruments, but may be most efficient with the BELA or L-CLIP. To control bleeding from larger vessels (3 mm or greater), however, the most effective and efficient approach may be to add additional laparoscopic ports for assistance, and maintain a low threshold for conversion to full laparoscopy.


Session: Poster
Program Number: P210
View Poster

373

Share this:

  • Twitter
  • Facebook
  • LinkedIn
  • Pinterest
  • WhatsApp
  • Reddit

Related

Hours & Info

11300 West Olympic Blvd, Suite 600
Los Angeles, CA 90064
1-310-437-0544
[email protected]
Monday - Friday
8am to 5pm Pacific Time

Find Us Around the Web!

  • Facebook
  • Twitter
  • YouTube
  • Instagram
  • TikTok

Important Links

SAGES 2024 Meeting Information

Healthy Sooner: Patient Information

SAGES Guidelines, Statements, & Standards of Practice

SAGES Manuals

 

  • taTME Study Info
  • Foundation
  • SAGES.TV
  • MyCME
  • Educational Activities

Copyright © 2023 Society of American Gastrointestinal and Endoscopic Surgeons