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© Georg Thieme Verlag KG Stuttgart · New York
An innovative, safe and sterile sigmoid access (ISSA) for NOTES
submitted 22 February 2007
accepted after revision 22 March 2007
22 May 2007 (online)
Background and study aims: The use of a transcolonic approach for natural orifice transluminal endoscopic surgery (NOTES) offers relevant advantages compared with a transgastric procedure. However both techniques are still limited by specific shortcomings that need to be resolved before the transluminal approach can be translated to human applications. In this article we describe an innovative method for a transcolonic procedure, which might represent the next step forward in NOTES.
Patients and methods: In three acute and five survival porcine models we evaluated a specially designed guide tube, which is inserted via a transcolonic approach into the abdominal cavity after intraperitoneal instillation of a decontamination solution. After endoscopic evaluation of the abdomen the closure of the entry site was performed surgically. Main parameters obtained in the study were the feasibility and safety of the approach, the bacterial contamination due to the transcolonic procedure, and the safe closure of the entry site. Animals in the survival model were euthanized 10 days after the procedure.
Results: The transcolonic approach took place without complications. There was no bleeding or laceration of adjacent organs. The surgical closure guaranteed a leak-proof closure of the entry site. All pigs in the survival model showed an excellent postinterventional course. At necropsy, the colonic incision sites were completely closed and appeared well healed. No abscesses or any sign of inflammation could be identified.
Conclusions: The transcolonic approach using an innovative guide tube is feasible and safe. The technique described offers mentionable advantages and therefore reduces the known shortcomings of NOTES. However, further studies are needed to approve our results of an initial evaluation.
- 1 Kalloo A N, Singh V K, Jagannath S B. et al . Flexible transgastric peritoneoscopy: a novel approach to diagnostic and therapeutic interventions in the peritoneal cavity. Gastrointest Endosc. 2004; 60 114-117
- 2 Pai R D, Fong D G, Bundga M E. et al . Transcolonic endoscopic cholecystectomy: a NOTES survival study in a porcine model (with video). Gastrointest Endosc. 2006; 64 428-434
- 3 Park P O, Bergstrom M, Ikeda K. et al . Experimental studies of transgastric gallbladder surgery: cholecystectomy and cholecystogastric anastomosis (videos). Gastrointest Endosc. 2005; 61 601-606
- 4 Bergstrom M, Ikeda K, Swain P, Park P O. Transgastric anastomosis by using flexible endoscopy in a porcine model (with video). Gastrointest Endosc. 2006; 63 307-312
- 5 Kantsevoy S V, Jagannath S B, Niiyama H. et al . Endoscopic gastrojejunostomy with survival in a porcine model. Gastrointest Endosc. 2005; 62 287-292
- 6 Wagh M S, Merrifield B F, Thompson C C. Survival studies after endoscopic transgastric oophorectomy and tubectomy in a porcine model. Gastrointest Endosc. 2006; 63 473-478
- 7 Jagannath S B, Kantsevoy S V, Vaughn C A. et al . Peroral transgastric endoscopic ligation of fallopian tubes with long-term survival in a porcine model. Gastrointest Endosc. 2005; 61 449-453
- 8 Ryou M, Pai R, Sauer J. et al . Evaluating an optimal gastric closure method for transgastric surgery. Surg Endosc. 2007; 21 677-680
- 9 Fong D G, Pai R D, Thompson C C. Transcolonic endoscopic abdominal exploration: a NOTES survival study in a porcine model. Gastrointest Endosc. 2007; 65 312-318
- 10 Ko C W, Kalloo A N. Per-oral transgastric abdominal surgery. Chin J Dig Dis. 2006; 7 67-70
- 11 Lima E, Rolanda C, Pego J M. et al . Transvesical endoscopic peritoneoscopy: a novel 5 mm port for intra-abdominal scarless surgery. J Urol. 2006; 176 802-805
- 12 Rolanda C, Lima E, Pego J M. et al . Third-generation cholecystectomy by natural orifices: transgastric and transvesical combined approach (with video). Gastrointest Endosc. 2007; 65 111-117
- 13 Rolanda C, Lima E, Correia-Pinto J. Searching the best approach for third-generation cholecystectomy. Gastrointest Endosc. 2007; 65 354
- 14 Bhoyrul S, Vierra M A, Nezhat C R. et al . Trocar injuries in laparoscopic surgery. J Am Coll Surg. 2001; 192 677-683
- 15 Wagh M S, Merrifield B F, Thompson C C. Endoscopic transgastric abdominal exploration and organ resection: initial experience in a porcine model. Clin Gastroenterol Hepatol. 2005; 3 892-896
- 16 Swanstrom L L, Kozarek R, Pasricha P J. et al . Development of a new access device for transgastric surgery. J Gastrointest Surg. 2005; 9 1129-1136; discussion 1136 - 1137
- 17 Lamade W, Hochberger J. Transgastric surgery: avoiding pitfalls in the development of a new technique. Gastrointest Endosc. 2006; 63 698-700
- 18 Merrifield B F, Wagh M S, Thompson C C. Peroral transgastric organ resection: a feasibility study in pigs. Gastrointest Endosc. 2006; 63 693-697
H. Feussner, MD
Department of Surgery
Klinikum r. d. Isar
Technical University Munich