Abstract
Background
Natural orifice transluminal endoscopic surgery (NOTES) for bowel resection is a challenging procedure. We studied the feasibility and safety of NOTES by performing cecectomy in dogs, which is equivalent to simple bowel resection in man.
Methods
Three dogs underwent transgastric endoscopic cecectomy with laparoscopic assistance. Antibiotics and irrigation were administered as preoperative preparation. A single-channel endoscope was introduced through the stomach into the peritoneal cavity, and the cecum was dissected and ligated with an L-knife and endoloops, respectively. Laboratory blood testing, peritoneal bacterial culture, and radiologic testing were performed perioperatively. Animals underwent autopsies on postoperative day (POD) 14.
Results
All subjects survived surgery and remained alive until POD 14. Mean operative time was 126.6 min. The absence of bacterial infections and anatomic leaks was verified by peritoneal swap culture, blood count, air leak testing, and bowel contrast radiology. However, a temporary mild elevation in white blood cell count was noted. No abscess or sign of infection was observed during autopsy, although adhesion was evident.
Conclusions
Transgastric endoscopic cecectomy with minimal laparoscopic assistance is a feasible and safe procedure. Cecectomy in dogs is equivalent to procedures such as appendectomy, resection of Meckel’s diverticulum, and oophorectomy in man. Natural orifice transluminal endoscopic surgery could prove to be a good optional surgical procedure.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Kalloo AN, Singh VK, Jagannath SB, Niiyama H, Hill SL, Vaughn CA, Magee CA, Kantsevoy SV (2004) Flexible transgastric peritoneoscopy: a novel approach to diagnostic and therapeutic interventions in the peritoneal cavity. Gastrointest Endosc 60:114–117
Wagh MS, Thompson CC (2007) Surgery insight: natural orifice transluminal endoscopic surgery—an analysis of work to date. Nat Clin Pract Gastroenterol Hepatol 4:386–392
Jeong SM, Kim YI, Lee JY, Jee HC, Park JY, Park JH, Kim JY, Lee SI, Kim MC, Shin ST, Lee YW (2007) Transgastric endoscopic cholecystectomy in a dog: natural orifice transluminal endoscopic surgery. J Vet Clin 24:315–319
McGee MF, Rosen MJ, Marks J, Onders R, Chak A, Faulx A, Chen VK, Ponsky J (2006) A primer on natural orifice transluminal endoscopic surgery: building a new paradigm. Surg Innov 13:86–93
Rattner D, Kalloo A, ASGE/SAGES Working Group on Natural Orifice Transluminal Endoscopic Surgery (2006) White Paper; ASGE/SAGES Working Group on Natural Orifice Transluminal Endoscopic Surgery, October 2005. Surg Endosc 20:329-333
Flora ED, Wilson TG, Martin IJ, O’Rourke NA, Maddern GJ (2008) A review of natural orifice transluminal endoscopic surgery (NOTES) for intra-abdominal surgery: experimental models, techniques, and applicability to the clinical setting. Ann Surg 247:583–602
Freeman LJ, Rahmani EY, Sherman S, Chiorean MV, Selzer DJ, Constable PD, Snyder PW (2009) Oophorectomy by natural orifice transluminal endoscopic surgery: feasibility study in dogs. Gastrointest Endosc 69(7):1321–1332
Kantsevoy SV, Jagannath SB, Niiyama H, Chung SS, Cotton PB, Gostout CJ, Hawes RH, Pasricha PJ, Magee CA, Vaughn CA, Barlow D, Shimonaka H, Kalloo AN (2005) Endoscopic gastrojejunostomy with survival in a porcine model. Gastrointest Endosc 62:287–292
Chiu PW, Lau JY, Ng EK, Lam CC, Hui M, To KF, Sung JJ, Chung SS (2008) Closure of a gastrotomy after transgastric tubal ligation by using the Eagle Claw VII: a survival experiment in a porcine model (with video). Gastrointest Endosc 68:554–559
Hookey LC, Khokhotva V, Bielawska B, Samis A, Jalink D, Hurlbut D, Mercer D (2009) The Queen’s closure: a novel technique for closure of endoscopic gastrotomy for natural-orifice transluminal endoscopic surgery. Endoscopy 41:149–153
Marks J, Rosen M, McGee M (2006) A novel technique for management of endoscopic gastrotomy following natural orifice transviseral endoscopic surgery. Surg Endosc 20:S287
Mintz Y, Horgan S, Cullen J, Stuart D, Falor E, Talamini MA (2008) NOTES: a review of the technical problems encountered and their solutions. J Laparoendosc Adv Surg Tech A 18:583–587
von Renteln D, Eickhoff A, Kaehler G, Riecken B, Caca K (2009) Endoscopic closure of the natural orifice transluminal endoscopic surgery (NOTES) access site to the peritoneal cavity by means of transmural resorbable sutures: an animal survival study. Endoscopy 41:154–159
Disclosures
Drs. Young-Ill Kim, Seong-Mok Jeong, and Ji-Yeon Kim are funded by the Korea Advanced Institute of Science and Technology (KAIST) as investigators at the Center for Future Medical Robotics and have no financial relationship with any pharmaceutical or device company. Drs. Snag-Il Lee, Jong-Hyun Park, and Chi-Woo Park have no conflicts of interest or financial ties to disclose.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Lee, SI., Park, JH., Park, CW. et al. Transgastric cecectomy in canine models: natural orifice transluminal endoscopic surgery (NOTES). Surg Endosc 24, 2387–2392 (2010). https://doi.org/10.1007/s00464-010-0959-4
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-010-0959-4