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New device for transrectal trocar placement and rectal sealing for NOTES: a porcine in vivo and human cadaver study

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Abstract

Background

To date, hybrid NOTES, combining transvaginal and laparoscopic access, represents the most popular clinically applied NOTES approach enabling surgical handling comparable to laparoscopic surgery. The transrectal route could be used in a similar way; however, suitable devices facilitating feasible transrectal access and rectal sealing are lacking.

Methods

In collaboration with Karl Storz GmbH, we tailored a rectoscope and trocars to facilitate transrectal trocar placement and rectal sealing for hybrid NOTES procedures using rigid instruments. Five German Landrace pigs underwent transrectal hybrid NOTES cholecystectomy using the new devices. In a second experiment, the transferability to human anatomy was assessed in a human cadaver.

Results

Using the new devices, transrectal trocar placement and rectal sealing proved to be feasible in both experiments. Transrectal hybrid NOTES cholecystectomy could be performed without complications.

Conclusion

The presented devices provide a tailored operating platform allowing precise transrectal trocar insertion and feasible sealing of the rectotomy. Consequently, these new instruments may pave the way for transrectal hybrid NOTES procedures and could succeed to clinical use in future.

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Acknowledgments

The authors wish to thank Béivin Pyne for revising this manuscript as a native English speaker.

Funding

This study was funded solely by institutional means from the University Hospital of Heidelberg. The tr-NOTES rectoscope and the tr-NOTES trocars were developed in collaboration with Karl Storz GmbH (Tuttlingen, Germany) based on the existing TEO instruments (Karl Storz GmbH). Regarding the presented devices, no patent agreement has been made. Manufactured prototypes were kindly provided by Karl Storz GmbH.

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Authors and Affiliations

  1. Department of General, Visceral and Transplant Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany

    Jonas D. Senft, Philip Gath, Tilman Dröscher, Philip C. Müller, Felix Nickel, Beat P. Müller-Stich & Georg R. Linke

  2. Department of Internal Medicine I, Robert Bosch Hospital, Auerbachstrasse 110, 70376, Stuttgart, Germany

    Benedict Carstensen

Authors
  1. Jonas D. Senft
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  2. Philip Gath
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  3. Tilman Dröscher
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  4. Philip C. Müller
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  5. Benedict Carstensen
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  6. Felix Nickel
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  7. Beat P. Müller-Stich
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  8. Georg R. Linke
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Corresponding author

Correspondence to Georg R. Linke.

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Disclosures

Authors Jonas D. Senft, Philip Gath, Tilman Dröscher, Philip C. Müller, Benedict Carstensen, Felix Nickel, Beat P. Müller-Stich and Georg R. Linke have no conflict of interest or financial ties to disclose.

Electronic supplementary material

Below is the link to the electronic supplementary material.

464_2016_4756_MOESM1_ESM.tiff

Supplemental Fig. 1: A The tr-NOTES rectoscope in situ position-stabilized by the working frame. B Placement of a 10-mm tr-NOTES trocar via the tr-NOTES rectoscope from an external view (TIFF 6711 kb)

Supplementary material 2 (TIFF 3976 kb)

Supplementary material 3 (MP4 53116 kb)

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Senft, J.D., Gath, P., Dröscher, T. et al. New device for transrectal trocar placement and rectal sealing for NOTES: a porcine in vivo and human cadaver study. Surg Endosc 30, 4383–4388 (2016). https://doi.org/10.1007/s00464-016-4756-6

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  • DOI: https://doi.org/10.1007/s00464-016-4756-6

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