Skip to main content
SpringerLink
Log in

NOTES Rectosigmoid Resection Using Transanal Endoscopic Microsurgery (TEM) with Transgastric Endoscopic Assistance: A Pilot Study in Swine

  • ssat plenary presentation
  • Published:
Journal of Gastrointestinal Surgery Aims and scope

Abstract

Introduction

Transanal endoscopic microsurgery (TEM) provides direct endoscopic access to the rectum and peritoneal cavity. The feasibility of natural orifice translumenal endoscopic surgery (NOTES) rectosigmoid resection using TEM was evaluated in swine. Transgastric endoscopic assistance to extend transanal colon mobilization was also investigated. Full-thickness circumferential rectal dissection was performed and extended proximally. After maximal sigmoid mobilization, the specimen was exteriorized and transected, and the proximal colon was stapled to the distal rectum. In a subset of animals, transgastric endoscopic access was used to mobilize the colon further.

Results

Rectosigmoid resection using TEM was performed in two non-survival and seven swine cadavers (n = 9). The mean procedure time was 3 h (2.5–4 h), and mean length of resected colon was 16.7 cm (10–25 cm). Transgastric endoscopic assistance was used in three cadavers and two non-survival swine (n = 5) with a mean operative time of 3.5 h (3.5–3.75 h). The mean length of colon mobilized with transgastric and transanal endoscopic access was 24.4 cm (20–27 cm) vs. 16.7 cm which mobilized the transanal approach alone (p = 0.016). A posterior anastomotic defect was noted in two animals.

Conclusion

Transanal rectosigmoid resection with TEM is feasible in swine. Combined transgastric and TEM access is a promising new technique for NOTES colorectal resection.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Figure 1
Figure 2
Figure 3

Similar content being viewed by others

References

  1. Wilhelm D, Meining A, von Delius S, Fiolka A, Can S, Hann von Weyhern C, et al. An innovative, safe and sterile sigmoid access (ISSA) for NOTES. Endoscopy 2007;39:401–406. doi:10.1055/s-2007-966438.

    Article  PubMed  CAS  Google Scholar 

  2. Fong DG, Pai RD, Thompson CC. Transcolonic endoscopic abdominal exploration: a NOTES survival study in a porcine model. Gastrointest Endosc 2007;65:312–318. doi:10.1016/j.gie.2006.08.005.

    Article  PubMed  Google Scholar 

  3. Pai RD, Fong DG, Bundga ME, Odze RD, Rattner DW, Thompson CC. Transcolonic endoscopic cholecystectomy: a NOTES survival study in a porcine model. Gastrointest Endosc 2006;64:428–434. doi:10.1016/j.gie.2006.06.079.

    Article  PubMed  Google Scholar 

  4. Fong DG, Ryou M, Pai RD, Tavakkolizadeh A, Rattner DW, Thompson CC. Transcolonic ventral wall hernia mesh fixation in a porcine model. Endoscopy 2007;39:865–869. doi:10.1055/s-2007-966916.

    Article  PubMed  CAS  Google Scholar 

  5. Ryou M, Fong DG, Pai RD, Tavakkolizadeh A, Rattner DW, Thompson CC. Dual-port distal pancreatectomy using a prototype endoscope and endoscopic stapler: a natural orifice transluminal endoscopic surgery (NOTES) survival study in a porcine animal model. Endoscopy 2007;39:881–887. doi:10.1055/s-2007-966908.

    Article  PubMed  CAS  Google Scholar 

  6. Matthes K, Yusuf TE, Willingham FF, Mino-Kenudson M, Rattner DW, Brugge WR. Feasibility of endoscopic transgastric distal pancreatectomy in a porcine animal model. Gastrointest Endosc 2007;66:762–766. doi:10.1016/j.gie.2007.02.042.

    Article  PubMed  Google Scholar 

  7. Whiteford MH, Denk PM, Swanstrom LL. Feasibility of radical sigmoid colectomy performed as natural orifice translumenal endoscopic surgery (NOTES) using transanal endoscopic microsurgery. Surg Endosc 2007;21:1870–1874. doi:10.1007/s00464-007-9552-x.

    Article  PubMed  CAS  Google Scholar 

  8. Marks JM, Ponsky JL, Pearl JP, McGee MF. PEG “rescue”: a practical NOTES technique. Surg Endosc 2007;21:816–819. doi:10.1007/s00464-007-9361-2.

    Article  PubMed  Google Scholar 

  9. Gettman MT, Blute ML. Transvesical peritoneoscopy: initial clinical evaluation of the bladder as a portal for natural orifice translumenal endoscopic surgery. Mayo Clin Proc 2007;82:843–845.

    Article  PubMed  Google Scholar 

  10. Hazey JW, Narula VK, Renton DB, Reavis KM, Paul CM, Hinshaw KE, et al. Natural orifice transgastric endoscopic peritoneoscopy in humans: Initial clinical trial. Surg Endosc 2008;22:16–20. doi:10.1007/s00464-007-9548-6.

    Article  PubMed  Google Scholar 

  11. Palanivelu C, Rajan PS, Rangarajan M, Parthasarathi R, Senthilnathan P, Prasad M. Transvaginal endoscopic appendectomy in humans: a unique approach to NOTES—world’s first report. Surg Endosc 2008;22:1343–1347.

    Article  PubMed  Google Scholar 

  12. Bessler M, Stevens PD, Milone L, Parikh M, Fowler D. Gastrointest Endosc 2007;66:1243–1245. doi:10.1016/j.gie.2007.08.017.

    Article  PubMed  Google Scholar 

  13. Marescaux J, Dallemagne B, Perretta S, Wattiez A, Mutter D, Coumaros D. Surgery without scars: report of translumenal cholecystectomy in a human being. Arch Surg 2007;142:823–826. doi:10.1001/archsurg.142.9.823.

    Article  PubMed  Google Scholar 

  14. Cataldo PA. Transanal endoscopic microsurgery. Surg Clin North Am 2006;86:915–925. doi:10.1016/j.suc.2006.06.004.

    Article  PubMed  Google Scholar 

  15. Gavagan JA, Whiteford MH, Swanstrom LL. Full-thickness intraperitoneal excision by transanal endoscopic microsurgery does not increase short-term complications. Am J Surg 2004;187:630–634. doi:10.1016/j.amjsurg.2004.01.004.

    Article  PubMed  Google Scholar 

  16. Wagh MS, Merrifield BF, Thompson CC. Endoscopic transgastric abdominal exploration and organ resection: initial experience in a porcine model. Clin Gastroenterol Hepatol 2005;3:892–896. doi:10.1016/S1542-3565(05)00296-X.

    Article  PubMed  Google Scholar 

  17. Park PO, Bergström M, Ikeda K, Fritscher-Ravens A, Swain P. Experimental studies of transgastric gallbladder surgery: cholecystectomy and cholecystogastric anastomosis (videos). Gastrointest Endosc 2005;61:601–606. doi:10.1016/S0016-5107(04)02774-9.

    Article  PubMed  Google Scholar 

  18. Hu B, Kalloo AN, Chung SS, Cotton PB, Gostout CJ, Hawes RH, et al. Peroral transgastric endoscopic primary repair of a ventral hernia in a porcine model. Endoscopy 2007;39:390–393. doi:10.1055/s-2007-966426.

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgments

We are grateful to Karl Storz and Covidien for providing the equipment to complete this pilot study.

Support

This study was supported in part by a grant from Natural Orifice Surgery Consortium for Assessment and Research (NOSCAR).

Author information

Author notes

  1. Patricia Sylla

    Present address: , 15 Parkman Street, WACC 460, Boston, MA, 02114, USA

Authors and Affiliations

  1. Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA

    Patricia Sylla, Denise Gee & David W. Rattner

  2. Department of Medicine, Gastrointestinal Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA

    Field F. Willingham & William R. Brugge

  3. Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea

    Dae K. Sohn

Authors
  1. Patricia Sylla
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Field F. Willingham
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Dae K. Sohn
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Denise Gee
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. William R. Brugge
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. David W. Rattner
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Patricia Sylla.

Additional information

Meeting presentations This study was accepted for presentation at the SSAT Plenary Session May 20, 2008 at Digestive Disease Week in San Diego, CA.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Sylla, P., Willingham, F.F., Sohn, D.K. et al. NOTES Rectosigmoid Resection Using Transanal Endoscopic Microsurgery (TEM) with Transgastric Endoscopic Assistance: A Pilot Study in Swine. J Gastrointest Surg 12, 1717–1723 (2008). https://doi.org/10.1007/s11605-008-0637-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11605-008-0637-1

Keywords

Search

Navigation