Surgical Endoscopy

, Volume 22, Issue 10, pp 2277–2278

NOTES: cadaveric rendezvous hybrid small bowel resection

  • Edward D. Auyang
  • Khashayar Vaziri
  • Eric Volckmann
  • John A. Martin
  • Nathaniel J. Soper
  • Eric S. Hungness
Video

DOI: 10.1007/s00464-008-0064-0

Cite this article as:
Auyang, E.D., Vaziri, K., Volckmann, E. et al. Surg Endosc (2008) 22: 2277. doi:10.1007/s00464-008-0064-0

Abstract

Background

Natural orifice translumenal endoscopic surgery (NOTES) is an emerging field in minimally invasive surgery that is driving the development of new technology and techniques [1–4]. Before NOTES gains widespread popularity, it must be proven to be a safe and efficacious technique [5]. There are several proposed benefits to the NOTES approach, including potentially decreased abdominal pain, wound infections, and hernia formation.

Methods

Currently, most investigational NOTES procedures are performed using a single transgastric, transcolonic, or transvaginal access point to the abdomen. In order to provide greater range of motion and freedom of movement, a rendezvous procedure using simultaneous transgastric and transcolonic approaches was used to perform a small bowel resection. This video demonstrates a successful NOTES hybrid small bowel resection with the use of two laparoscopic ports in a cadaveric model. A powered stapling device attached to a flexible shaft is introduced transcolonically and facilitates division and re-anastamosis of the small bowel. A dual-channel operating endoscope introduced transgastrically allows for precise dissection and creation of enterotomies necessary for the small bowel resection.

Conclusions

While technically challenging, NOTES hybrid small bowel resection can be accomplished with specially designed instrumentation utilizing the rendezvous technique. There are several technical limitations preventing this procedure from being completed in a pure NOTES fashion. A safe method of creating blind enterotomies will be needed to eliminate laparoscopic visualization of the enterotomy sites. Adequate endoscopic exposure and retraction of tissue is still difficult and currently requires percutaneous adjuncts. New closure devices will be needed for safe and reliable NOTES enterotomy closure. With the development of such instruments, this, as well as other NOTES procedures, will become more technically feasible.

Keywords

NOTES Transgastric Transcolonic Small bowel Rendezvous Surgical endoscopy 

Supplementary material

ESM (MPG 99.3 MB)

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • Edward D. Auyang
    • 1
  • Khashayar Vaziri
    • 1
  • Eric Volckmann
    • 1
  • John A. Martin
    • 1
    • 2
  • Nathaniel J. Soper
    • 1
  • Eric S. Hungness
    • 1
  1. 1.Division of GI and Endocrine Surgery, Department of SurgeryNorthwestern University Feinberg School of MedicineChicagoUSA
  2. 2.Department of MedicineNorthwestern University Feinberg School of MedicineChicagoUSA

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