Basic Study
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World J Gastroenterol. May 21, 2022; 28(19): 2112-2122
Published online May 21, 2022. doi: 10.3748/wjg.v28.i19.2112
Snare-assisted flexible endoscope in trans-gastric endoscopic gallbladder-preserving surgery: A pilot animal study
Xian-Wen Guo, Yun-Xiao Liang, Peng-Yu Huang, Lie-Xin Liang, Yi-Qing Zeng, Zhen Ding
Xian-Wen Guo, Zhen Ding, Department of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei Province, China
Xian-Wen Guo, Yun-Xiao Liang, Peng-Yu Huang, Lie-Xin Liang, Yi-Qing Zeng, Department of Gastroenterology, The People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning 530021, Guangxi Zhuang Autonomous Region, China
Author contributions: Guo XW and Ding Z contributed equally to this work; Guo XW and Ding Z were responsible for the study concept and design, including endoscopic procedures; all authors conducted the endoscopic operations together; Guo XW drafted the manuscript; Ding Z revised and finalized the manuscript.
Supported by National Natural Science Foundation of China, No. 82060104; and Construction of Guangxi Clinical Medical Research Center for Digestive Diseases, No. AD17129027.
Institutional review board statement: The study was reviewed and approved by the Ethics Committee of the People's Hospital of Guangxi Zhuang Autonomous Region and the Ethics Committee of the Tongji Medical College, No. KY-LW-2019-4, [2020]-S322.
Institutional animal care and use committee statement: All procedures involving animals were reviewed and approved by the Institutional Animal Care and Use Committee of People's Hospital of Guangxi Zhuang Autonomous Region (No. KY-LW-2019-4) and the Institutional Animal Care and Committee at Huazhong University of Science and Technology Tongji Medical College (No. 2625).
Conflict-of-interest statement: To the best of our knowledge, no conflict of interest exists.
Data sharing statement: No additional data are available.
ARRIVE guidelines statement: The authors have read the ARRIVE guidelines, and the manuscript was prepared and revised according to the ARRIVE guidelines.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Zhen Ding, PhD, Chief Doctor, Department of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1277 Jiefang Avenue, Wuhan 430022, Hubei Province, China. docd720@126.com
Received: December 19, 2021
Peer-review started: December 19, 2021
First decision: March 10, 2022
Revised: March 23, 2022
Accepted: April 15, 2022
Article in press: April 15, 2022
Published online: May 21, 2022
Processing time: 148 Days and 20.8 Hours
ARTICLE HIGHLIGHTS
Research background

With the development of medicine, the operation and concept of preserving the gallbladder and curing benign gallbladder diseases are now widely supported. As an emerging technology, gallbladder-preservation surgery via natural orifice transluminal endoscopic surgery (NOTES) has obvious advantages in the complete resection of gallbladder polyps, removal of gallbladder stones, improvement of gallbladder inflammation, and preservation of gallbladder function. However, there are some technical obstacles to the clinical application of this operation. For example, the gallbladder bed is close to the liver, is obscured by fatty tissue, and has a poor field of vision, indicating that it can be difficult to locate the gallbladder. In addition, the gallbladder collapses and shrinks quickly after incision, and the instruments used for gallbladder operation lose their focus, thereby making the operation very difficult.

Research motivation

The single-channel flexible endoscope for gallbladder-preservation surgery via NOTES requires additional navigation and traction. We proposed a new operative method that involved using a snare to assist in the traction and positioning of the gallbladder.

Research objectives

This study aimed to evaluate the feasibility and safety of a new surgical method, “snare-assisted pure NOTES gallbladder-preserving surgery”.

Research methods

Eight miniature pigs were randomly divided into the experimental group [NOTES gallbladder-preserving surgery using the snare device, snare assisted (SA)] and the control group (NOTES gallbladder-preserving surgery without using the snare device, NC), with four cases in each group. The differences between the two groups of animals in operating time, operating workload, complications, adverse events, white blood cells, and liver function were determined.

Research results

No differences were found in the surgical success rate, gallbladder incision closure, white blood cell count, or liver function between the two groups. The total operating time, gallbladder incision blood loss, gallbladder disorientation time, gallbladder incision closure time, and workload scores of the National Aeronautics and Space Administration-Task Load Index were significantly reduced in the SA group (P < 0.05).

Research conclusions

These results indicated that snare-assisted pure NOTES gallbladder-preservation surgery using standard endoscopic instruments reduced the difficulty of the operation, shortened operation time, and did not increase complications in pigs.

Research perspectives

A new method for pure NOTES gallbladder-preservation surgery was provided. Translating this new technology to human subjects seems straightforward and has great practical value in the clinic.