Abstract
Background
Because of size limitation, the lack of reliable instruments, and bladder closure methods, transvesical natural orifice translumenal endoscopic surgery (NOTES) is still in its infancy. The porcine uterine horn is similar to the human vermiform appendix. Therefore, the resection of the porcine uterine horn is an established animal model for the human appendectomy. In this study, we evaluated the feasibility of a pure transvesical NOTES approach to uterine horn resection in a porcine model.
Methods
We performed five operations on three female pigs (30–35 kg) under general anesthesia in the Trendelenburg position. The laparoscope at the umbilicus was used only for the purpose of documentation. We used a rigid ureteroscope and a customized access system that prevented gas leakage and facilitated in-and-out passage of the instruments. A vesicostomy was created on the posterolateral bladder wall by using a needle knife through the channel of the ureteroscope. The uterine horn resection was performed by using an electric needle knife, hot forceps, and a polypectomy snare through the access system placed in vesicostomy. Bladder closure was performed with extracorporeal ties using metal clip tagged threads and a knot-pusher.
Results
We successfully performed the pure transvesical NOTES uterine horn resections. The mean total operative time was 141.8 (±58.7) min, and blood loss was minimal in all cases. No leakage was observed at the bladder repair sites after filling with normal saline. The removed uterine horns were approximately 6–12-cm long and 0.6–0.8 cm in diameter. On final inspection, the urethras were not damaged.
Conclusions
This study demonstrates the feasibility of a pure transvesical NOTES uterine horn resection in a porcine model. To the best of our knowledge, this is the world’s first report on a pure transvesical NOTES with a therapeutic purpose. This study shows the potential for adoption of the transvesical approach in NOTES procedures.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Gettman MT, Cadeddu JA (2008) Natural orifice translumenal endoscopic surgery (NOTES) in urology: initial experience. J Endourol 22:783–788
Swain P (2008) Nephrectomy and natural orifice translumenal endoscopy (NOTES): transvaginal, transgastric, transrectal, and transvesical approaches. J Endourol 22:811–818
Granberg CF, Frank I, Gettman MT (2009) Transvesical NOTES: current experience and potential implications for urologic applications. J Endourol 23:747–752
Lima E, Rolanda C, Correia-Pinto J (2009) NOTES performed using multiple ports of entry: current experience and potential implications for urologic applications. J Endourol 23:759–764
Lima E, Henriques-Coelho T, Rolanda C, Pego JM, Silva D, Carvalho JL, Correia-Pinto J (2007) Transvesical thoracoscopy: a natural orifice translumenal endoscopic approach for thoracic surgery. Surg Endosc 21:854–858
Lima E, Rolanda C, Pego JM, Henriques-Coelho T, Silva D, Carvalho JL, Correia-Pinto J (2006) Transvesical endoscopic peritoneoscopy: a novel 5 mm port for intra-abdominal scarless surgery. J Urol 176:802–805
Sumiyama K, Gostout CJ, Rajan E, Bakken TA, Deters JL, Knipschield MA, Hawes RH, Kalloo AN, Pasricha PJ, Chung S, Kantsevoy SV, Cotton PB (2006) Pilot study of the porcine uterine horn as an in vivo appendicitis model for development of endoscopic transgastric appendectomy. Gastrointest Endosc 64:808–812
Jayaraman S, Schlachta CM (2009) Transgastric and transperineal natural orifice translumenal endoscopic surgery (NOTES) in an appendectomy test bed. Surg Innov 16:223–227
Gettman MT, Lotan Y, Napper CA, Cadeddu JA (2002) Transvaginal laparoscopic nephrectomy: development and feasibility in the porcine model. Urology 59:446–450
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
Xavier K, Gupta M, Landman J (2009) Transgastric NOTES: current experience and potential implications for urologic applications. J Endourol 23:737–741
Box GN, Bessler M, Clayman RV (2009) Transvaginal access: current experience and potential implications for urologic applications. J Endourol 23:753–757
Kaouk JH, Haber GP, Goel RK, Crouzet S, Brethauer S, Firoozi F, Goldman HB, White WM (2010) Pure natural orifice translumenal endoscopic surgery (NOTES) transvaginal nephrectomy. Eur Urol 57:723–726
Branco AW, Branco Filho AJ, Kondo W, Noda RW, Kawahara N, Camargo AA, Stunitz LC, Valente J, Rangel M (2008) Hybrid transvaginal nephrectomy. Eur Urol 53:1290–1294
Alcaraz A, Peri L, Molina A, Goicoechea I, Garcia E, Izquierdo L, Ribal MJ (2010) Feasibility of transvaginal NOTES-assisted laparoscopic nephrectomy. Eur Urol 57:233–237
Sotelo R, de Andrade R, Fernandez G, Ramirez D, Di Grazia E, Carmona O, Moreira O, Berger A, Aron M, Desai MM, Gill IS (2010) NOTES hybrid transvaginal radical nephrectomy for tumor: stepwise progression toward a first successful clinical case. Eur Urol 57:138–144
Kaouk JH, White WM, Goel RK, Brethauer S, Crouzet S, Rackley RR, Moore C, Ingber MS, Haber GP (2009) NOTES transvaginal nephrectomy: first human experience. Urology 74:5–8
Sylla P, Sohn DK, Cizginer S, Konuk Y, Turner BG, Gee DW, Willingham FF, Hsu M, Mino-Kenudson M, Brugge WR, Rattner DW (2010) Survival study of natural orifice translumenal endoscopic surgery for rectosigmoid resection using transanal endoscopic microsurgery with or without transgastric endoscopic assistance in a swine model. Surg Endosc 24:2022–2030
Autorino R, Cadeddu JA, Desai MM, Gettman M, Gill IS, Kavoussi LR, Lima E, Montorsi F, Richstone L, Stolzenburg JU, Kaouk JH (2011) Laparoendoscopic single-site and natural orifice transluminal endoscopic surgery in urology: a critical analysis of the literature. Eur Urol 59:26–45
Rolanda C, Lima E, Pego JM, Henriques-Coelho T, Silva D, Moreira I, Macedo G, Carvalho JL, Correia-Pinto J (2007) Third-generation cholecystectomy by natural orifices: transgastric and transvesical combined approach (with video). Gastrointest Endosc 65:111–117
Lima E, Rolanda C, Pego JM, Henriques-Coelho T, Silva D, Osorio L, Moreira I, Carvalho JL, Correia-Pinto J (2007) Third-generation nephrectomy by natural orifice transluminal endoscopic surgery. J Urol 178:2648–2654
Metzelder ML, Vieten G, Gosemann J, Ure B, Kuebler JF (2009) Rigid NOTES: the transurethral approach in female piglets. J Laparoendosc Adv Surg Tech A 19:581–587
Sawyer MD, Cherullo EE, Elmunzer BJ, Schomisch S, Ponsky LE (2009) Pure natural orifice translumenal endoscopic surgery partial cystectomy: intravesical transurethral and extravesical transgastric techniques in a porcine model. Urology 74:1049–1053
Box G, Averch T, Cadeddu J, Cherullo E, Clayman R, Desai M, Frank I, Gettman M, Gill I, Gupta M, Haber GP, Kaouk J, Landman J, Lima E, Ponsky L, Rane A, Sawyer M, Humphreys M (2008) Nomenclature of natural orifice translumenal endoscopic surgery (NOTES) and laparoendoscopic single-site surgery (LESS) procedures in urology. J Endourol 22:2575–2581
Gettman MT, Blute ML (2007) Transvesical peritoneoscopy: initial clinical evaluation of the bladder as a portal for natural orifice translumenal endoscopic surgery. Mayo Clin Proc 82:843–845
Fisher RE (2000) The primate appendix: a reassessment. Anat Rec 261:228–236
Lee SI, Park JH, Park CW, Kim YI, Jeong SM, Kim JY (2010) Transgastric cecectomy in canine models: natural orifice transluminal endoscopic surgery (NOTES). Surg Endosc 24:2387–2392
Lima E, Rolanda C, Osorio L, Pego JM, Silva D, Henriques-Coelho T, Carvalho JL, Bergstrom M, Park PO, Mosse CA, Swain P, Correia-Pinto J (2009) Endoscopic closure of transmural bladder wall perforations. Eur Urol 56:151–157
Disclosures
Chang Wook Jeong, Jong Jin Oh, Murad Abdullajanov, Jaeseung Yeon, Hahn-Ey Lee, Seong Jin Jeong, Sung Kyu Hong, Seok-Soo Byun, Seung Bae Lee, Hyeon Hoe Kim, and Sang Eun Lee have no conflicts of interest or financial ties to disclose.
Author information
Authors and Affiliations
Corresponding author
Electronic supplementary material
Below is the link to the electronic supplementary material.
Supplementary material 1 (WMV 32943 kb)
Supplementary material 2 (WMV 46826 kb)
Supplementary material 3 (WMV 24505 kb)
Rights and permissions
About this article
Cite this article
Jeong, C.W., Oh, J.J., Abdullajanov, M. et al. Pure transvesical NOTES uterine horn resection in swine as an appendectomy model. Surg Endosc 26, 558–564 (2012). https://doi.org/10.1007/s00464-011-1905-9
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-011-1905-9