Natural orifice transluminal endoscopic surgery applied to sigmoidectomy in survival animal models: using paired magnetic intra-luminal device
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The clinical application of natural orifice transluminal endoscopic surgery (NOTES) for sigmoidectomy is associated with several difficulties that need to be overcome before wider clinical application of the procedure. The purpose of this study was to evaluate the technical feasibility and safety of transgastric sigmoidectomy in a survival animal model, as well as to evaluate the safety and usability of a custom paired magnetic intraluminal device, which we developed for the NOTES procedure.
Survival experiments were conducted on 24–33-kg dogs. After anesthesia, a gastrotomy was created using double-channel endoscope, and peritoneoscopy was performed. The sigmoid colon was retracted laterally using paired magnetic intraluminal device, the mesocolon was dissected, and the branch vessel was sealed. The anvil was placed into the descending colon through anus. A proximal and distal colonic transection was then performed. The circular stapler was passed through the anus and performed end-to-end anastomosis. Afterwards the specimen was removed through gastrotomy, and the gastric incision was closed. Postoperatively, all dogs were recovered and monitored for well-being during convalescence. Reexploration was practiced under anesthesia 2 weeks after surgery for evaluation of intra-abdominal complications, and intra-peritoneal cultures for microorganism.
The mean operative time was 141 (range, 122–157) min. There were no complications or physical evidence of sepsis or bowel obstruction during the observation period. Only one dog exhibited decreased body weight, decreasing to 20.4 kg from 22.4 kg after surgery; all of the other dogs exhibited increased body weight. We observed no evidence of peritonitis, intra-abdominal abscess, bleeding, or organ injury on reexploration conducted on day 14 after surgery.
Transgastric NOTES sigmoidectomy is a safe operation technique as evaluated in a dog model. The paired magnetic intraluminal device that was used in this study was useful to avoid an abdominal incision for retracting the sigmoid colon.
KeywordsMinimally invasive surgery NOTES Natural Orifice transluminal endoscopic surgery Sigmoidectomy Magnet
This work was supported by the Samsung Biomedical Research Institute grant SBRI C-A9-237-1 (Seoul, Korea). The authors thank to Hyuknam Kwon, who remodeled a flexible sigmoidoscope for this study.
Drs Yong Beom Cho, Jun Ho Park, Ho-Kyung Chun, Chi-Min Park, Hee Cheol Kim, Seong Hyeon Yun, and Woo Yong Lee have no conflict of interest or financial ties to disclosure.
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- 5.Wilk PJ (1994) Method for use in intra-abdominal surgery. US patent: 5297536Google Scholar
- 6.Bowman DE (2006) ASGE/SAGES working group on natural orifice transluminal endoscopic surgery. White paper October 2005. Gastrointest Endosc 63:199–203Google Scholar
- 13.Jagannath SB, Kantsevoy SV, Vaughn CA, Chung SS, Cotton PB, Gostout CJ, Hawes RH, Pasricha PJ, Scorpio DG, Magee CA, Pipitone LJ, Kalloo AN (2005) Peroral transgastric endoscopic ligation of fallopian tubes with long-term survival in a porcine model. Gastrointest Endosc 61:449–453PubMedCrossRefGoogle Scholar
- 16.Jamirdar Pa MC, Cadeddu M, Boyd M, Swain P (2008) Retraction force measurement during transgastric and transvaginal NOTES. Gastrointest Endosc 67:S1369Google Scholar
- 18.Best SL, Bergs R, Gedeon M, Paramo J, Fernandez R, Cadeddu JA, Scott DJ (2010) Maximizing coupling strength of magnetically anchored surgical instruments: how thick can we go? Surg Endosc. doi: 10.1007/s00464-010-1149-0