Endoscopy 2007; 39(5): 401-406
DOI: 10.1055/s-2007-966438
Original article

© Georg Thieme Verlag KG Stuttgart · New York

An innovative, safe and sterile sigmoid access (ISSA) for NOTES

D.  Wilhelm1, 2 , A.  Meining3 , S.  von   Delius3 , A.  Fiolka2 , S.  Can2 , C.  Hann von Weyhern4 , A.  Schneider2 , H.  Feussner1, 2
  • 1Department of Surgery, Klinikum r. d. Isar, Technical University, Munich, Germany
  • 2Workgroup for minimal invasive Surgery MITI, Klinikum r. d. Isar, Technical University, Munich, Germany
  • 32nd Medical Department, Klinikum r. d. Isar, Technical University, Munich, Germany
  • 4Institute for Pathology, Klinikum r. d. Isar, Technical University, Munich, Germany
Further Information

Publication History

submitted 22 February 2007

accepted after revision 22 March 2007

Publication Date:
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.


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H. Feussner, MD 

Department of Surgery

Klinikum r. d. Isar

Technical University Munich



Fax: 0049-89-4140-4851

Email: feussner@chir.med.tu-muenchen.de