Single-port flexible endoscopic enterolysis under the guidance of electromagnetic navigation in a hypochlorite-induced abdominal adhesions pig model.

PURPOSE: Small bowel obstruction (SBO) usually resolves with medical therapy but requires surgery, preferentially under the guidance of laparoscopy. We performed single-port flexible endoscopic enterolysis for abdominal adhesions under the guidance of dual-channel electromagnetic navigation technology and evaluated the feasibility and safety of this method in a pig model.

METHOD: Hypochlorite-induced abdominal adhesions was induced in 8 pigs. A long gastric tube with a magnetic navigation wire (sensor 1) was inserted into the distal end of the small intestine. The electromagnetic signal emitter was activated, and a second magnetic navigation wire (sensor 2) was continuously adjusted on the abdominal surface to obtain the two coordinates closest to the incised skin. The trocar was placed, and pneumoperitoneum was established. An endoscope with a second wire was placed through the trocar, and diagnostic intraperitoneal endoscopy was performed. The fibrotic bands and peritoneal congestion were observed, and the fibrous bands were dissected with a Dual knife.

RESULTS

Abdominal adhesions model was evaluated. One case experienced intraoperative bleeding because the small mesenteric artery was damaged. Both the peritoneum and operating space were sufficiently visible in all cases except one, in which intestinal inflation significantly affected visibility. Seven of 8 (87.5%) of fibrous bands were successfully dissected. The total procedure duration was 48 (35-60) mins. Compared with that in the hypochlorite-induced abdominal adhesions model, weight gain was 6 (4-9) kg.

CONCLUSION

Flexible endoscopy adhesiolysis under the guidance of electromagnetic navigation for abdominal adhesions is comparatively safe and feasible.