Abstract
Background
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.
Methods
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 The sigmoid colon was retracted laterally using paired magnetic intraluminal device, the mesocolon was dissected, and the branch vessel was sealed.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.
Results
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.
Conclusions
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.
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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
Rattner D, Kalloo A (2006) ASGE/SAGES working group on natural orifice transluminal endoscopic surgery. Surg Endosc 20:329–333
Ponsky JL (2005) Gastroenterologists as surgeons: what they need to know. Gastrointest Endosc 61:454
Hochberger J, Lamade W (2005) Transgastric surgery in the abdomen: the dawn of a new era? Gastrointest Endosc 62:293–296
Wilk PJ (1994) Method for use in intra-abdominal surgery. US patent: 5297536
Bowman DE (2006) ASGE/SAGES working group on natural orifice transluminal endoscopic surgery. White paper October 2005. Gastrointest Endosc 63:199–203
Marescaux J, Dallemagne B, Perretta S, Wattiez A, Mutter D, Coumaros D (2007) Surgery without scars: report of transluminal cholecystectomy in a human being. Arch Surg 142:823–826 discussion 826–827
Whiteford MH, Denk PM, Swanstrom LL (2007) Feasibility of radical sigmoid colectomy performed as natural orifice transluminal endoscopic surgery (NOTES) using transanal endoscopic microsurgery. Surg Endosc 21:1870–1874
Lacy AM, Delgado S, Rojas OA, Almenara R, Blasi A, Llach J (2008) MA-NOS radical sigmoidectomy: report of a transvaginal resection in the human. Surg Endosc 22:1717–1723
Leroy J, Cahill RA, Perretta S, Forgione A, Dallemagne B, Marescaux J (2009) Natural orifice transluminal endoscopic surgery (NOTES) applied totally to sigmoidectomy: an original technique with survival in a porcine model. Surg Endosc 23:24–30
Wagh MS, Merrifield BF, Thompson CC (2005) Endoscopic transgastric abdominal exploration and organ resection: initial experience in a porcine model. Clin Gastroenterol Hepatol 3:892–896
Kantsevoy SV, Jagannath SB, Niiyama H, Isakovich NV, Chung SS, Cotton PB, Gostout CJ, Hawes RH, Pasricha PJ, Kalloo AN (2007) A novel safe approach to the peritoneal cavity for per-oral transgastric endoscopic procedures. Gastrointest Endosc 65:497–500
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 61:449–453
Park PO, Bergstrom M, Ikeda K, Fritscher-Ravens A, Swain P (2005) Experimental studies of transgastric gallbladder surgery: cholecystectomy and cholecystogastric anastomosis (videos). Gastrointest Endosc 61:601–606
Wagh MS, Merrifield BF, Thompson CC (2006) Survival studies after endoscopic transgastric oophorectomy and tubectomy in a porcine model. Gastrointest Endosc 63:473–478
Jamirdar Pa MC, Cadeddu M, Boyd M, Swain P (2008) Retraction force measurement during transgastric and transvaginal NOTES. Gastrointest Endosc 67:S1369
Leroy J, Cahill RA, Asakuma M, Dallemagne B, Marescaux J (2009) Single-access laparoscopic sigmoidectomy as definitive surgical management of prior diverticulitis in a human patient. Arch Surg 144:173–179 discussion 179
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
Lehman AC, Dumpert J, Wood NA, Visty AQ, Farritor SM, Oleynikov D (2008) In vivo robotics for natural orifice transgastric peritoneoscopy. Stud Health Technol Inform 132:236–241
Lehman AC, Dumpert J, Wood NA, Redden L, Visty AQ, Farritor S, Varnell B, Oleynikov D (2009) Natural orifice cholecystectomy using a miniature robot. Surg Endosc 23:260–266
Lehman AC, Dumpert J, Wood NA, Visty AQ, Farritor SM, Varnell B, Oleynikov D (2009) Natural orifice transluminal endoscopic surgery with a miniature in vivo surgical robot. Surg Endosc 23:1649
Haber GP, Crouzet S, Kamoi K, Berger A, Aron M, Goel R, Canes D, Desai M, Gill IS, Kaouk JH (2008) Robotic NOTES (natural orifice transluminal endoscopic surgery) in reconstructive urology: initial laboratory experience. Urology 71:996–1000
Acknowledgement
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.
Disclosures
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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Yong Beom Cho and Jun Ho Park contributed equally to this work.
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Cho, Y.B., Park, J.H., Chun, HK. et al. Natural orifice transluminal endoscopic surgery applied to sigmoidectomy in survival animal models: using paired magnetic intra-luminal device. Surg Endosc 25, 1319–1324 (2011). https://doi.org/10.1007/s00464-010-1365-7
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DOI: https://doi.org/10.1007/s00464-010-1365-7