“No scar” small bowel resection in a survival porcine model using transcolonic NOTES® and transabdominal approach
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Fundamental techniques and essential tools for performing “no scar” surgery still need to be developed. Our study was designed to evaluate the feasibility of performing small bowel resection by transcolonic NOTES® and transabdominal approach using rigid laparoscopic and flexible endoscopic instruments.
One non survival and four survival experiments were performed using a porcine model. The endoscope with an overtube was advanced into the peritoneal cavity through the colotomy. Mini-laparoscopic instruments were placed through the abdominal wall under the endoscopic observation. The endoscope was replaced with a rigid linear stapler. The small bowel was identified. The segment of the small bowel was resected by firing the endo stapler, and extracted through the colon. The two limbs of the small bowel were approximated with two stay-sutures. An enterotomy was then created on the antimesenteric sides of each line. A side-to-side anastomosis was performed with another application of the endo stapler. The stapler was withdrawn. The enterotomy was closed by suturing. The colotomy was closed with endoclips and the endoscope was withdrawn. The mini-laparoscopic instruments were removed.
Small bowel resection was successfully performed in all animals. The surgery time was 70 minutes. There was no mortality or complications. The animals recovered uneventfully, and survived the 2 weeks postprocedure period. They remained healthy, and gained weight. Necropsy was performed 2 weeks after the surgery. On necropsy, evaluation of the abdominal skin revealed no scars. The peritoneal cavity was examined. No signs of infection, bleeding, perforations, and adhesions were noted. Endoscopic examination of the colotomy and anastomosis revealed complete healing that was confirmed by histopathology.
The study has demonstrated the feasibility of small bowel resection using transcolonic NOTES® and transabdominal approach. Simultaneous use of flexible endoscopic and rigid laparoscopic instruments in NOTES® is not only feasible but has significant advantages and greatly facilitates the performance of the operation, yet leaves no scars.
KeywordsSmall Bowel Peritoneal Cavity Colonic Wall Small Bowel Resection Transabdominal Approach
The authors thank the American Society for Gastrointestinal Endoscopy and Pentax Medical Co. for providing training and video recording equipment; Olympus Canada Inc., Karl Storz Endoscopy Canada Ltd., AMT Endoscopy and Covidien for providing the study with free of charge endoscopic and laparoscopic equipment.
Drs. Dubcenco, Eng, Streutker, Baxter, Rotstein, and Baker have no conflicts of interest or financial ties to disclose. Dr. Grantcharov received research support grant from Covidien, Canada.
Video Clip “NO SCAR small bowel resection”. The video demonstrates our step-by-step technique for small bowel resection using transcolonic NOTES® and transabdominal approach. (MPG 70592 kb)
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