Thèse soutenue

Evaluation et optimisation des techniques d'abord transgastrique de la cavité péritonéale en chirurgie endoscopique transluminale par les orifices naturels (natural orifice translumenal endoscopic surgery, notes)
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Auteur / Autrice : Xavier Dray
Direction : Philippe Marteau
Type : Thèse de doctorat
Discipline(s) : Biologie
Date : Soutenance en 2009
Etablissement(s) : Paris, CNAM

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Résumé

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NOTES (Natural Orifice Translumenal Endoscopic Surgery) is a surgical technique that aims to gain access to the peritoneal cavity with a flexible endoscope, through a natural orifice and through the wall of the digestive or urogenital tract. Mastering the per-oral transgastric route (available to both genders, as opposed to the transvaginal route) is an important challenge for the development of this technique. The studies presented in this thesis demonstrate the feasibility of transgastric endoscopic procedures in a live porcine model. This work emphasizes: (1) the need for a prevention of infection prior to transgastric NOTES procedures; (2) the interest of a preliminary pneumoperitoneum before the creation of the transgastric access, to prevent any damage of the surrounding organs; (3) the safe use of a balloon-dilation technique for creation of the transgastric access, as compared to the use of a sphincterotome-incision ; (4) the feasibility of intraperitoneal delivery of sterile prothetic material during NOTES, as illustrated by the transgastric NOTES ventral hernia repair technique; (5) the need for technological improvement for safe, quick and reliable transgastric access to the peritoneal cavity (for example by using a 2 µm wavelength laser) and gastrotomy closure (for example with hemoclips, threaded-tags