Abstract
Background and aim
Natural orifice transluminal endoscopic surgery (NOTES) cholecystectomy is an emerging technology. Interest is ongoing and developments have been rapid but NOTES cholecystectomy has failed to gain traction. Here, we share our experience of snare-assisted pure NOTES retrograde cholecystectomy using porcine models.
Materials and methods
Under general anesthesia, an incision was created on the posterior vagina wall and an endoscope with a snare attached to the transparent cap was introduced into the pelvic cavity and then upward into peritoneal cavity. After locating the liver and gallbladder, the fundic wall of gallbladder was grasped using a biopsy forceps and the snare was released to ligate the fundus. The gallbladder was then carefully dissected from the gallbladder bed using hook/IT knives with the assistance of the snare. The cystic duct and cystic artery were identified, clipped twice and isolated from the gallbladder using the hook knife to cut between the clips. The specimen was then removed through the vagina using the snare.
Results
This procedure was successfully performed in 8 consecutive pigs. The average procedure time was 53 min (range 40–60 min). No severe bleeding or other complication was observed either during or after the procedure. Normal diets were given on the same day of the procedure. All animals recovered uneventfully.
Conclusion
We successfully performed snare-assisted pure NOTES retrograde cholecystectomy in pigs using standard endoscopic instruments. In our experience, pure NOTES cholecystectomy using the retrograde approach performed with a single channel flexible endoscope proved safe and feasible with a short procedure time and quick recovery. The translation of this technique to human subjects seems straight forward and provides a new fitting path to pure NOTES.
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Abbreviations
- NOTES:
-
Natural orifice transluminal endoscopic surgery
- LC:
-
Laparoscopic cholecystectomy
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Acknowledgements
We express our gratitude to Professor David Y. Graham, MD. Professor of Medicine, Molecular Virology and Microbiology, Baylor college of Medicine for his encouragement and assistance in revising the manuscript. In addition, Saif Ullah wants to thank one person in particular Tanchanok Samermuan for her patience, care and support over the past three years. Tanchanok Samermuan will you marry me?
Funding
National natural science foundation of China (No.818704540). Henan province innovation talents of science and technology plan (No. 184200510020). The research team fund of the First affiliated Hospital of Zhengzhou University.
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Study concept and design: BRL, SU. Manuscript writing: SU, BRL. Analysis and interpretation of data: DL, SU. Acquisition of data: DL, DL, SU; LJK. Administrative, technical or material support: LXZ; WY. Video editing: JYZ. Obtained funding: BRL. Critical revision of manuscript and video: BRL.
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Drs Bing-Rong Liu, Saif Ullah, De-Liang Li, Dan Liu, Li-Xia Zhao, Wenyi Yang, Ling-Jian Kong and Ji-Yu Zhang have no conflicts of interest and financial ties to disclose.
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Video 1: Technical description of pure NOTES retrograde Cholecystectomy. (MP4 151926 kb)
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Liu, BR., Ullah, S., Li, DL. et al. A snare-assisted pure NOTES retrograde cholecystectomy using a single channel flexible endoscope: a pilot experiment in a porcine model. Surg Endosc 34, 3706–3710 (2020). https://doi.org/10.1007/s00464-020-07561-0
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DOI: https://doi.org/10.1007/s00464-020-07561-0