Percutanous Ultrathin Flexible Peritoneoscopy for Detecting Peritoneal Metastasis: A Feasibility Study

ABSTRACT

BACKGROUND/AIMS: Preoperative diagnosis of peritoneal metastasis is extremely important to select the appropriate treatment strategy and predict the prognosis for patients with gastrointestinal cancer. However, imaging techniques have a limited capacity for detecting peritoneal metastasis. We therefore evaluated the feasibility of percutaneous ultrathin flexible peritoneoscopy in an animal model. MATERIALS AND METHODS: Percutanous ultrathin flexible peritoneoscopy was performed on two mini-pigs under general anesthesia. We punctured the abdominal wall at the anti-Mcburney and umbilical regions using a 16-gauge angiocatheter. Guidewire was inserted through the angiocatheter and we then enlarged the puncture using a biliary dilation catheter and a 6- to 8-mm balloon dilator catheter. After track formation, we inserted a 4.9-mm ultrathin endoscope into the abdominal cavity. The peritoneal cavity was examined, and peritoneal and liver biopsy was performed. The puncture was closed with a single suture. After the procedure, we monitored the general condition of the pigs for 2 weeks. RESULTS: Percutaneous ultrathin flexible peritoneoscopy was successfully performed regardless of the puncture site location. Peritoneal and liver biopsy was also successfully executed. The mean procedure time was 20 minutes. Formation of the abdominal track was not easily accomplished with standard endoscopic equipment. Nevertheless, none of the abdominal organs were injured. The post-procedure course was uneventful. Minor scarring was observed at the incision site 2 weeks after the procedure. CONCLUSIONS: Percutanous ultrathin flexible peritoneoscopy is a relatively simple and technically feasible method. However, dedicated accessories for fascial dilation should be developed to ensure the safety of human patients undergoing this procedure.