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1.
Evaluation for transvaginal and transgastric NOTES cholecystectomy in human and animal natural orifice translumenal endoscopic surgery 总被引:1,自引:0,他引:1
Maki Sugimoto Hideki Yasuda Keiji Koda Masato Suzuki Masato Yamazaki Tohru Tezuka Chihiro Kosugi Ryota Higuchi Yoshihisa Watayo Yohsuke Yagawa Shuichiro Uemura Hironori Tsuchiya Atsushi Hirano Shoki Ro 《Journal of Hepato-Biliary-Pancreatic Surgery》2009,16(3):255-260
Background/purpose Natural orifice translumenal endoscopic surgery (NOTES) is a novel concept using an endoscope via a translumenal access for
abdominal surgery. This study was designed to evaluate the feasibility and technical aspects of NOTES cholecystectomy from
our experience on humans and animals.
Methods NOTES cholecystectomies were performed in 12 animal experiments, including 8 pigs (6 by transgastric and 2 by transvaginal
accesses) and 4 dogs (4 transvaginal accesses), and a human female cadaver.
Results The entire gallbladder could be removed under direct vision in all experiments. The average time was 60 min by transgastric
and 40 min by transvaginal in animals. It was 87 min for human transvaginal cholecystectomy. In all animal and human procedures,
there was no major complication concerning the operation.
Discussion The transvaginal route may be the easiest route for abdominal NOTES. Percutaneous endoscopic gastrostomy (PEG) allowed the
safe performance of a controlled gastric perforation and shortened the time. The hybrid method allowed performance of a safe
procedure and shortened the time.
Conclusions Transvaginal and transgastric NOTES cholecystectomy is technically feasible and safe in both humans and animals. New instrumentation
needs to be developed to perform a pure NOTES cholecystectomy without transabdominal assistance. 相似文献
2.
Zorrón R Filgueiras M Maggioni LC Pombo L Lopes Carvalho G Lacerda Oliveira A 《Surgical innovation》2007,14(4):279-283
Natural Orifice Translumenal Endoscopic Surgery is a new development area with potential advantages for patients. However, technical and ethical challenges involved in perforation and closure of a healthy organ, as seen in transgastric access, and lack of comprehension of physiopathology of these approaches haven't allowed clinical application. The present study, based on previous animal experiments, describes the first clinical application of transvaginal Natural Orifice Translumenal Endoscopic Surgery. On March 13, 2007, a 43-year-old female patient with symptomatic cholelithiasis with surgical indication was submitted to elective Natural Orifice Translumenal Endoscopic Surgery transvaginal cholecystectomy using a colonoscope, endoscopic graspers, and vaginal platform instruments. Operative time was 66 minutes, and vaginal access and closure were obtained in 15 minutes. The patient had good postoperative evolution and was dismissed within 48 hours without complications. Recent literature and experience of the present study group suggest possibilities for preliminary clinical applications by transvaginal natural orifice surgery. The access may offer earlier benefits in the literature than the transgastric route because of lack of danger of fistula and peritonitis. Further studies regarding instrument development and physiology of natural orifice surgery are ongoing, possibly bringing solutions for more advanced procedures. 相似文献
3.
Challenges and lessons learned from NOTES cholecystectomy initial experience: a stepwise approach from the laboratory to clinical application 总被引:1,自引:0,他引:1
Mitsuhiro Asakuma Silvana Perretta Pierre Allemann Ronan Cahill Sergio A. Con Cinthya Solano Shanker Pasupathy Didier Mutter Bernard Dallemagne Jacques Marescaux 《Journal of Hepato-Biliary-Pancreatic Surgery》2009,16(3):249-254
Background/Purpose The initial idea behind natural orifice transluminal endoscopic surgery (NOTES) was that of an incisionless surgery. NOTES
cholecystectomy is a good model of human ingenuity and technological advance. NOTES cholecystectomy in a human being was performed
at our institution after extensive laboratory work in live pig models. In this process we gained helpful information related
to NOTES cholecystectomy.
Methods More than 250 cholecystectomies in pigs have been performed. From May 2007 to November 2008 a total of 10 and 6 transvaginal
and transgastric human cholecystectomies, respectively, have been performed.
Results The procedure was successful in all patients, with a mean operative time of 120 min. There were no intraoperative or postoperative
complications. Patients recovered promptly after surgery and had minor postoperative pain. They were discharged on the second
postoperative day.
Conclusions The advantages of laparoscopy appeared to be enhanced by this approach: patients had minor postoperative pain and minimal
scarring. This stepwise experience in the cholecystectomy procedure is an important first step in the development of methods
and devices to enable the evaluation of potential incisionless NOTES surgery. Additional research and comparison studies are
needed for further improvement in order to provide NOTES procedures to a wider range of patients. 相似文献
4.
Palanivelu C Rajan PS Rangarajan M Parthasarathi R Senthilnathan P Prasad M 《Surgical endoscopy》2008,22(5):1343-1347
Background Natural orifice translumenal endoscopic surgery (NOTES) is the newest technique emerging in the field of surgery. There are
several techniques described in the literature; however there is no standardization yet. We describe the transvaginal approach
for endoscopic appendectomy in humans, probably the world’s first report.
Materials and methods Pneumoperitoneum was achieved via a Veress needle in the umbilicus. Routine 12-mm endoscope and routine instruments were used.
Peritoneal access was gained via a transvaginal approach through the posterior fornix.
Results Out of a total of six patients, a totally endoscopic transvaginal appendectomy was successfully performed for one patient.
The other five patients were either converted to conventional laparoscopy or aided by a laparoscope. The average age of the
patients was 29.5 years. The mean operating time was 103.5 min. Hospital stay was 1–2 days. The follow-ups were scheduled
at 7 days, 30 days, 90 days, and 6 months. The vaginal wound was examined by the gynecologist and found to have completely
healed during the first and second follow–up.
Discussion So far in humans, transgastric appendectomy and cholecystectomy, and transvaginal cholecystectomy have been reported. A transvaginal
endoscopic appendectomy in humans has not been reported yet. The transvaginal approach provided a normal image of the target
organ, unlike the inverted image of a transgastric approach caused by the inability to manipulate the scope outside the mouth.
The technical ease of the procedure and early outcome seem satisfactory, although comparative studies are needed to confirm
this. 相似文献
5.
Hybrid transvaginal cholecystectomy, NOTES, and minilaparoscopy: analysis of a prospective clinical series 总被引:1,自引:0,他引:1
José Noguera Carlos Dolz Angel Cuadrado José Olea Angels Vilella Rafael Morales 《Surgical endoscopy》2009,23(4):876-881
Introduction Natural orifice transluminal endoscopic surgery (NOTES) makes it possible to perform intraperitoneal surgical procedures with
a minimal number of access points in the abdominal wall. It is not yet possible to perform these interventions without the
help of abdominal wall entryways, so these procedures are hybrids, a fusion of minilaparoscopy and transluminal endoscopic
surgery. In this paper we present a prospective clinical series of 15 patients who underwent transvaginal hybrid cholecystectomy
for cholelithiasis.
Methods This was a prospective clinical series of 15 consecutive female patients, nonrandomly chosen and without a control group,
who underwent a fusion transvaginal NOTES and minilaparoscopy procedure with two entryways for cholelithiasis. One was umbilical
and measured 5 mm in diameter, and the other was in the right upper quadrant and measured 3 mm in diameter.
Results The scheduled surgical intervention was performed on the 15 patients in whom it had been indicated. There were no intraoperative
complications. One patient had mild hematuria that resolved in less than 12 h; there were no other complications after average
follow-up of 124 days. Nine patients were discharged in 24 h, and two were discharged less than 12 h after the procedure.
Discussion Hybrid transvaginal cholecystectomy is a good surgical model for minimally invasive surgery, a combination of NOTES and minilaparoscopy.
It can be performed in surgical settings where laparoscopy is practised regularly, using the instruments normally used for
endoscopy and laparoscopic surgery. Owing to the reproducibility of the intervention and the ease of vaginal closure, hybrid
transvaginal cholecystectomy will permit further development of NOTES in the future. 相似文献
6.
Natural Orifice Translumenal Endoscopic Surgery (NOTES) Transvaginal Cholecystectomy in a Morbidly Obese Patient 总被引:2,自引:0,他引:2
Decarli L Zorron R Branco A Lima FC Tang M Pioneer SR Zanin I Schulte AA Bigolin AV Gagner M 《Obesity surgery》2008,18(7):886-889
Transvaginal natural orifice translumenal endoscopic surgery (NOTES) is a new diagnostic and potentially therapeutic method of surgical endoscopy. The first case of NOTES transvaginal cholecystectomy in a morbid obese patient in the literature is described. IRB approval was obtained at the institution for transvaginal NOTES clinical trials. A 58-year-old female patient with cholelithiasis, hypertension, and type II diabetes, and BMI of 35.8 kg/m(2) was submitted to the technique. After transvaginal access, a two-channel gastroscope was introduced into the abdominal cavity along with a laparoscopic trocar. There were 2 umbilical punctures for use of 3 mm laparoscopic equipment. Operative time was 85 min. There was no use of postoperative analgesia, and the patient was discharged on the third postoperative day. Transvaginal NOTES is a feasible alternative method for cholecystectomy in the morbidly obese, although available technology is limited for natural orifice surgery. 相似文献
7.
Luiz Henrique de Sousa José Américo Gomides de Sousa Luiz Henrique de Sousa Filho Murilo Miranda de Sousa Vitor Miranda de Sousa Ana Patricia Miranda de Sousa Ricardo Zorron 《Surgical endoscopy》2009,23(11):2550-2555
Background
Clinical applications of transvaginal Natural Orifice Transluminal Endoscopic Surgery (NOTES) are still limited in the literature, mostly case reports performed by hybrid procedures with laparoscopic assistance. Avoiding complications from incisions is the main goal for natural orifice surgery. This study reports on a technique developed at our institution that uses two endoscopes inserted into the vagina to perform a Totally NOTES (T-NOTES) transvaginal cholecystectomy, and describes preliminary results.Methods
IRB approval was obtained at the institution for transvaginal NOTES clinical trials, and informed consent was obtained. The technique of T-NOTES transvaginal cholecystectomy was clinically applied in four female patients with symptomatic cholelithiasis, and data were prospectively documented. Transvaginal NOTES access was obtained by direct vaginal incision, and two endoscopes were simultaneously introduced in the abdominal cavity. Dissection was accomplished with available endoscopic instruments. Ligation of cystic duct and artery was performed using endoscopic clips. Vaginal closure was achieved using the direct-vision sutured technique.Results
The technique was successfully performed in the four patients. Insufflation and spatial orientation was of good quality. Mean operative time was 210 min. There were no complications during the 30-day follow-up. Postoperative course was uneventful, and patients were released from the hospital on the first postoperative day.Conclusion
Tranvaginal T-NOTES using two endoscopes provides a feasible method for natural orifice cholecystectomy using available technology. Large-series studies are needed to evaluate the results with respect to safety of the approach. 相似文献8.
Natural orifice translumenal endoscopic surgery (NOTES) involves the intentional puncture of one of the viscera (e.g., stomach,
rectum, vagina, urinary bladder) with an endoscope to access the abdominal cavity and perform an intraabdominal operation.
Early laboratory work focused on feasibility studies, including such accomplishments as pure transgastric splenectomy and
gastrojejunostomy. Contemporary laboratory work is investigating the infectious and immunologic implications of NOTES and
honing the tools and techniques required for complex abdominal operations. Today NOTES has entered the clinical arena in a
few cases: the first clinical series of transgastric peritoneoscopy has recently been published; multiple groups are accumulating
patients in studies of NOTES cholecystectomy, either via the transgastric or transvaginal route; and a series of transgastric
appendectomies has been well publicized, yet it remains unpublished. Although clinical NOTES is gaining momentum, the field
should remain in check while rigorous laboratory work is performed and cogent clinical trials are undertaken. The zeal for
NOTES should not take precedence over the welfare of the patient. 相似文献
9.
Marc Bessler Andrew A. Gumbs Luca Milone John C. Evanko Peter Stevens Dennis Fowler 《Surgical endoscopy》2010,24(9):2316-2317
Enthusiasm for natural orifice transluminal endoscopic surgery (NOTES) has been partly tempered by the reality that most NOTES
procedures to date have been laparoscopically assisted. After safely performing transvaginal cholecystectomy in an IACUC-approved
porcine model, the authors embarked on an institution review board (IRB)-approved protocol for ultimate performance of pure
NOTES cholecystectomy in humans. They describe their experience performing a true NOTES transvaginal cholecystectomy after
safely accomplishing three laparoscopically assisted or hybrid procedures in humans. One of the patients was a 35-year-old
woman presenting with symptoms of biliary colic. Ultrasound confirmed gallstones, and her liver enzymes were normal. Pneumoperitoneum
to 15 mmHg was obtained via a transvaginal trocar placed through a colpotomy made under direct vision. A double-channel endoscope
then was advanced into the abdomen. To overcome the retracting limitations of currently available endoscopes, the authors
used an extra-long 5-mm articulating retractor placed into the abdomen via a separate colpotomy made under direct vision using
the flexible endoscope in a retroflexed position. Endoscopically placed clips were used for control of both the cystic duct
and the artery. These techniques obviated the need for any transabdominally placed instruments or needles. This patient was
the first to undergo a completely NOTES cholecystectomy at the authors’ institution, and to their knowledge, in the United
States. She was discharged on the day of surgery and at this writing has not experienced any complication after 1 month of
follow-up evaluation. Performance of NOTES transvaginal cholecystectomy without aid of laparoscopic or needleoscopic instruments
is feasible and safe for humans. Additional experience with this technique are required before studies comparing it with standard
laparoscopy and hybrid techniques are appropriate. 相似文献
10.
妇科腹腔镜技术至今已日臻完善,但也同样面临着如何寻找更加体现微创理念、加速康复和给患者更多人文关怀的问题。近年兴起的经阴道自然腔道内镜手术(natural orifice transluminal endoscopic surgery,NOTES)无腹壁切口瘢痕,实现理想的美容效果,术后疼痛减轻,能达到加速康复目的。由于经阴道NOTES所需器械均通过阴道切口,与传统多孔腹腔镜手术和阴式手术差别较大。笔者就经阴道NOTES在妇科手术中的应用现状进行综述,并探讨在妇科领域的价值。 相似文献