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1.
Maki Sugimoto 《Journal of Hepato-Biliary-Pancreatic Surgery》2009,16(3):247-248
Introduction Natural orifice translumenal endoscopic surgery (NOTES) has captured the interest of interventional endoscopists and may represent
the next stage of evolution of minimally invasive surgery. It provides the potential for performance of incisionless operations.
It is gaining momentum both in the animal laboratory and in human case reports. Developments in the field of NOTES have led
to the formation of the Natural Orifice Surgery Consortium for Assessment and Research (NOSCAR) in 2006.
Materials and methods In this special issue, the current trends in NOTES in the field of hepatobiliary and pancreatic surgery are featured, including
NOTES cholecystectomy, hepatectomy splenectomy, pancreatic necrosectomy, and the future of NOTES. In this issue, we discuss
the potential benefits of these procedures in hepatobiliary and pancreatic surgery.
Conclusion We have just started the evaluation process for this new technology. The concept of NOTES is becoming established and is enormously
advantageous for the patient. Both the surgeon and gastroenterologist should contribute to developing NOTES in making use
of their specialties. 相似文献
2.
Crouzet S Haber GP Kamoi K Berger A Brethauer S Gatmaitan P Gill IS Kaouk JH 《BJU international》2008,102(11):1715-1718
OBJECTIVE
To present our laboratory experience with natural orifice translumenal endoscopic surgery (NOTES) renal cryoablation.MATERIALS AND METHODS
In two female farm pigs, we performed four procedures of NOTES renal cryoablation. In each pig, NOTES was performed through a transgastric approach and a transvaginal approach for each kidney, respectively. The pig was placed in the flank position and pneumoperitoneum obtained using a transabdominal Veress needle. In the first pig, we started with the left kidney with a transgastric approach: a dual‐channel video gastroscope (Olympus, Tokyo, Japan) was used, the stomach wall was punctured using a needle‐knife, a guidewire was passed into the abdominal cavity and the access dilated using a controlled radial expansion balloon. The bowel was mobilized medially and the Gerota’s fascia overlying the upper pole was dissected. Under direct endoscopic vision, a cryoablation probe was introduced percutaneously into the anterior upper pole of the kidney. The pig was then flipped to the right flank position and a transvaginal approach was used: the gastroscope was introduced through the posterior fornix of the vagina. For the second pig, we performed initially a transgastric right‐side cryoablation then a transvaginal left‐side cryoablation as described for the first pig.RESULTS
All four procedures were performed successfully, with no intraoperative complications. No additional laparoscopic ports or open conversions were necessary. The vision of the kidney and the ice‐ball was adequate for all cases. The mean operative duration was 83 min. Stomach closure was tested watertight, and there were no abdominal or pelvic injuries found at autopsy.CONCLUSIONS
NOTES can provide adequate minimal surgical dissection for safe and effective percutaneous renal cryoablation under direct videoscopic monitoring at kidney locations otherwise not accessible percutaneously. Both transgastric and transvaginal approaches can be used effectively for renal cryoablation providing a minimally invasive scar‐less surgery. 相似文献3.
Silvana Perretta Pierre Allemann Mitsuhiro Asakuma Bernard Dallemagne Jacques Marescaux 《Surgical endoscopy》2009,23(6):1390-1390
Background Endoscopic adrenalectomy currently is performed using either a retroperitoneal or transperitoneal approach. The retroperitoneal
approach is ideal for patients with small lesions who have undergone previous intraabdominal surgery. This study aimed to
explore transvaginal retroperitoneal right and left adrenalectomies in porcine and cadaver models.
Methods Right and left adrenalectomies were performed for two female pigs. With the pig supine under general anaesthesia, the retroperitoneal
space was entered with a double-channel endoscope (Storz) through a posterior colpotomy. A retroperitoneal tunnel was fashioned
using blunt dissection with the assistance of low carbon dioxide insufflation up to the inferior pole of the kidney. Dissection
of the upper renal pole allowed access to the adrenal gland. Using blunt dissection, a plane was created between the aorta
on the left and the adrenal gland and inferior vena cava on the right. The left main middle vascular pedicle was identified
and taken between clips, whereas an endoloop was used on the right side. The specimen was retrieved intact with a polypectomy
snare. The same access then was reproduced with two female cadavers.
Results Transvaginal retroperitoneal adrenalectomies were successfully accomplished with a transvaginal approach using natural orifice
translumenal endoscopic surgery (NOTES). The operative time was 70 min, and there was no injury to the retroperitoneal structures.
The access was effectively reproduced in the cadaver model, with prompt identification of the retroperitoneal anatomic landmarks.
Conclusion Transvaginal retroperitoneal NOTES adrenalectomy is feasible in the porcine model. It reaches the adrenal proper anatomic
plane with no need for dissection or retraction of the surrounding organs. This technique might be especially valuable for
patients with multiple previous abdominal operations and obese patients in that allows direct access to the adrenal gland
and minimizes the cardiovascular and pulmonary risk related to carbon dioxide pneumoperitoneum. Although the operation was
successfully validated with cadavers, further experiments and better tools are needed before NOTES transvaginal retroperitoneal
access is considered for humans.
Electronic supplementary material The online version of this article (doi:) contains supplementary material, which is available to authorized users. 相似文献
4.
Meireles OR Kantsevoy SV Assumpcao LR Magno P Dray X Giday SA Kalloo AN Hanly EJ Marohn MR 《Surgical endoscopy》2008,22(7):1609-1613
Background Reliable closure of the translumenal incision is one of the main challenges facing natural orifice translumenal endoscopic
surgery (NOTES). This study aimed to evaluate the use of an automated flexible stapling device (SurgASSIST) for closure of
the gastrotomy incision in a porcine model.
Methods A double-channel gastroscope was advanced into the stomach. A gastric wall incision was made, and the endoscope was advanced
into the peritoneal cavity. After peritoneoscopy, the endoscope was withdrawn into the stomach. The SurgASSIST stapler was
advanced orally into the stomach. The gastrotomy edges were positioned between the opened stapler arms using two endoscopic
grasping forceps. Stapler loads with and without a cutting blade were used for gastric closure. After firing of the stapler
to close the gastric wall incision, x-ray with contrast was performed to assess for gastric leakage. At the end of the procedure,
the animals were killed for a study of closure adequacy.
Results Four acute animal experiments were performed. The delivery and positioning of the stapler were achieved, with technical difficulties
mostly due to a short working length (60 cm) of the device. Firing of the staple delivered four rows of staples. Postmortem
examination of pig 1 (when a cutting blade was used) demonstrated full-thickness closure of the gastric wall incision, but
the cutting blade caused a transmural hole right at the end of the staple line. For this reason, we stopped using stapler
loads with a cutting blade. In the three remaining animals (pigs 2–4), we were able to achieve a full-thickness closure of
the gastric wall incision without any complications.
Conclusions The flexible stapling device may provide a simple and reliable technique for lumenal closure after NOTES procedures. Further
survival studies are currently under way to evaluate the long-term efficacy of gastric closure with the stapler after intraperitoneal
interventions.
Presented in part at the Society of American Gastrointestinal Endoscopic Surgeons (SAGES) Annual Meeting, Las Vegas, Nevada,
April 2007. 相似文献
5.
6.
Background Bowel anastomosis is one of the most challenging and difficult tasks to perform during natural orifice translumenal endoscopic
surgery (NOTES). The difficulty is mainly due to the technical limitations of the endoscopic instruments available. Currently,
endoscopic clips, T-bar sutures, or cumbersome suturing devices are used. A dual-lumen NOTES approach can facilitate bowel
resection in a pig model by allowing the use of laparoscopic staplers through the rectum.
Methods Acute studies were performed on four 40-kg pig models. The dual-lumen NOTES approach was used to perform small bowel resection
and anastomosis. An endoscope was passed into the stomach and pushed through the stomach wall into the peritoneal cavity (first
lumen), and a 12-mm trocar was placed through the anterior rectal wall, allowing access to the peritoneum (second lumen).
Handling of the bowel, resection, and anastomosis were performed using endoscopic instruments through the gastric lumen and
laparoscopic instruments through the rectal lumen. The resected small bowel then was removed through the rectum.
Results Small bowel resection and anastomosis was successfully completed in all four animals using the dual-lumen NOTES approach.
The laparoscopic stapler was used one more time to close the gastrotomy through the rectal port. At autopsy, intact suture
lines were noted at the bowel anastomosis and at the stomach, with no evidence of leak from either site.
Conclusions Performing a sutured anastomosis in NOTES is complex and time consuming. The use of stapling devices designed for laparoscopic
procedures greatly facilitates gastrointestinal tract operations in NOTES. Using both the upper and lower gastrointestinal
tract as entry sites for NOTES eliminates some of the current technical limitations of these procedures.
Presented at the 2007 society of American Gastrointestinal Endoscopic Surgeons (SAGES) Meeting. 相似文献
7.
Natural orifice translumenal endoscopic surgery (NOTES) in urology: initial experience 总被引:1,自引:0,他引:1
BACKGROUND AND PURPOSE: For years, urologists have been champions of surgery performed through natural body openings. The next frontier is intraperitoneal or retroperitoneal surgery performed via natural body openings. We reviewed the initial experience with natural orifice translumenal endoscopic surgery (NOTES) in urology. METHODS: The first experimental application of NOTES was published in 2002 when transvaginal nephrectomy was performed in the porcine model. Confirmatory experimental studies using the gastrointestinal tract for NOTES were first published in 2004. The bladder was first experimentally evaluated as a portal for NOTES in 2006. Urologists have developed and evaluated novel magnetic anchoring systems and operative platforms for NOTES. To date, clinical application of NOTES in urology is limited to transvesical peritoneoscopy. RESULTS: Analysis of the literature suggests that technologic, anatomic, physiologic, ethical, and philosophical questions must be answered before NOTES will be widely introduced or justified clinically. The premise that NOTES will be associated with a better recovery and fewer postoperative risks also remains to be evaluated. CONCLUSIONS: Largely in experimental models, urologists have show feasibility of NOTES. Ongoing evaluation and the introduction of new technologies are required for the field to advance. In addition, NOTES should be carefully embraced only after detailed evaluations prove a measured benefit in comparison to established minimally invasive techniques. 相似文献
8.
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
9.
Background Natural orifice translumenal endoscopic surgery (NOTES), a recent development in the field of minimally invasive surgery,
may offer advantages over open and laparoscopic surgery. Most investigations to date have focused on small end-organ resections,
and none have described en bloc regional lymphadenectomy. This study aimed to describe a method of anal transcolonic sigmoid
colon resection.
Methods A fresh frozen then thawed cadaver model was used. Three male human cadavers were subjected to transanal sigmoid colon mobilization,
high vascular ligation, en bloc lymphadenectomy, and stapled end-to-end anastomosis performed by a single operator using transanal
endoscopic microsurgery instrumentation.
Results The findings showed that NOTES sigmoid colon resection with en bloc lymphadenectomy and primary anastomosis can be performed
successfully. The critical steps of the procedure were (1) luminal suture occlusion of the sigmoid colon, (2) transrectal
bowel division, (3) entry through the mesorectum into the presacral space, (4) en bloc mobilization of the sigmoid colon mesentery
off of the retroperitoneum, (5) high ligation of the superior hemorrhoidal artery, (6) transanal delivery of the intact sigmoid
colon specimen, (7) extracorporeal division of the colon, and (8) creation of a stapled end-to-end colorectal anastomosis.
Postprocedure laparotomy confirmed adequate lymphadenectomy and anastomosis with no untoward events.
Conclusions It is possible to complete the critical steps of a NOTES sigmoid resection, en bloc lymphadenectomy, primary anastomosis,
and retrieval of an intact specimen without any incisions using transanal endoscopic microsurgery instrumentation. 相似文献
10.
Leroy J Cahill RA Perretta S Forgione A Dallemagne B Marescaux J 《Surgical endoscopy》2009,23(1):24-30
Background Natural orifice translumenal endoscopic surgery (NOTES) continues to evolve. This study investigated the feasibility and outcome
of performing localized sigmoidectomy in its entirety via NOTES.
Methods A survival study of five male minipigs (mean weight, 30 kg) was conducted. After anesthesia, a gastrotomy was created by a
per os double-channel endoscope, and full peritoneoscopy was performed. A Berci needle then was inserted transparietally to
allow maintenance and monitoring of the pneumoperitoneum. Using a transanal probe to facilitate intestinal retraction, the
mesentery was dissected with instruments worked through the channels of the transgastric endoscope. The anvil of a circular
stapler then was passed per anum into the colon above the point of intended transection. A penetrating transrectal trocar
was placed to allow entry of a linear stapler into the peritoneum through a colotomy, and the sigmoid was cross-stapled proximally.
The strut of the anvil then was snugged into a colotomy made at this staple line. The specimen was delivered via the anus
by a “pull-through” technique. The distal sigmoidal margin was cross-stapled extracorporeally, ensuring that the colotomy
was included within the specimen. Retrograde passage of the circular stapler head per anus allowed colocolonic reanastomosis
by its mating with the anvil already in situ. The gastrotomy was closed with a previously validated prosthesis. Postoperatively,
all the animals were recovered and monitored for well-being during convalescence. Endoscopy (gastroscopy and sigmoidoscopy),
laparoscopy, and laparotomy were performed on postoperative day 14 as follow-up measures.
Results Each operation was satisfactorily completed. The mean operative time was 76 min (range, 44–95 min). All the animals prospered
postoperatively. Follow-up examination showed full healing of all anastomoses and gastrotomy sites. There was no evidence
of luminal stricturing, peritonitis, or intraabdominal sepsis in any animal.
Conclusions Using this experimental model, colonic resection and reanastomosis can be performed safely within the NOTES format.
Presented at S032 NOTES Sigmoid Resection at SAGES, April 9–12, 2008. 相似文献
11.
BACKGROUND: NOTES is advancing at a rapid pace with large registries of human applications and increasing evidence to support
safety and efficacy. We have however arrived at a stage in the development of the technique where many conceptual applications
are not supported by available technology to ensure safe implementation. METHODS: The data presented in this editorial are
based on the views of the authors and reviews of the literature which have been conducted using PubMed, a search tool of the
National Library of Medicine and the national institute of Health, including the MEDLINE database and the Cochrane library
until the 1st of February 2011. RESULTS: This editorial reviews the technological challenges that must be overcome and novel
solutions are discussed. CONCLUSIONS: For NOTES to realise its full potential, surgeons have to wait for technology to catch
up with ideological innovation before embarking on more complex procedures than the hybrid transvaginal feasibility studies
currently taking place. 相似文献
12.
Ugur Boylu Mathew Oommen Virendra Joshi Raju Thomas Benjamin R. Lee 《Surgical endoscopy》2010,24(2):485-489
Background
This study aimed to evaluate the feasibility of natural orifice translumenal endoscopic surgery (NOTES) transgastric partial nephrectomy without hilar clamping in a porcine model. 相似文献13.
经自然腔道内镜手术是一种新型的微创手术,其发展尚面临诸多技术问题。笔者就该手术的操作平台、手术入路和切口闭合等关键问题的研究进展进行综述。 相似文献
14.
15.
Natural orifice translumenal endoscopic surgery (NOTES) is a sophisticated form of endoscopic surgery whose use has recently
spread rapidly around the world. Although hundreds of reports of animal studies and clinical cases about NOTES have been published
since 2004, NOTES is still in the experimental phase. The formation of an iatrogenic incision in the lumenal wall of intraperitoneal
organs is a major disadvantage of NOTES. No reliable technique for complete closure has yet been established, and this problem
must be resolved before NOTES can be adopted as a routine clinical practice. Several devices for the closure of lumenal incisions
in the stomach or colorectum have been developed, and their safety and usefulness have been examined in animal studies and
clinical cases. Kyushu University has been involved in furthering the adoption of NOTES as a routine clinical practice, and
the Kyushu University Training Center for Minimally Invasive Surgery holds training sessions on endoscopic surgical techniques
for surgeons from all over Japan. Studies to develop a navigation system and robotic technology for use with NOTES are also
in progress at Kyushu University. The further development of endoscopy-related technologies and equipment, such as robotic
technology, is therefore essential to allow the safe, widespread adoption of pure NOTES. 相似文献
16.
Natural orifice translumenal endoscopic surgery: critical appraisal of applications in clinical practice 总被引:1,自引:1,他引:0
Mikael H. Sodergren James Clark Thanos Athanasiou Julian Teare Guang-Zhong Yang Ara Darzi 《Surgical endoscopy》2009,23(4):680-687
Background Natural orifice translumenal endoscopic surgery (NOTES), with its focus on eliminating incision-related complications, promises
to revolutionize the way surgery is performed. This study aimed to summarize the clinical applications of NOTES for humans,
outline the techniques used, and discuss the complications and limitations of current techniques.
Methods A literature search was performed using PubMed and Medline search tools to review the extent and outcomes of human procedures
undertaken using the NOTES technique in its pure form or as a hybrid procedure reported until July 2008. The end points were
the types of operation performed, the approach and technique used for each operation, and the procedure-related complications
and technical limitations.
Results This review considered 16 publications reporting on 49 human subjects. All the studies except three used hybrid NOTES procedures,
with varying amounts of transabdominal assistance. Three transvaginal cholecystectomies, one transvaginal appendectomy, and
eight transgastric appendectomies have been performed using a pure NOTES technique. To date, 15 NOTES transvaginal cholecystectomies
and 10 NOTES appendectomies (8 transgastric and 2 transvaginal) are reported. Other procedures including peritoneoscopy and
sigmoid colectomy are described. Three cases of minor morbidity are reported and no mortality.
Conclusions Although initial human results seem encouraging, it is important that this research be conducted in a way that minimizes bad
publicity and describes both favorable and adverse outcomes. Robust trials must be conducted at established centers with appropriate
experience and institutional board ethical review to allow safe introduction of this novel technique, with adequate and expedient
reporting of serious adverse events. The limitations of the current tools and methods are discussed, and suggestions are made
for further improvements in the technology to facilitate NOTES operations. 相似文献
17.
Mintz Y Horgan S Savu MK Cullen J Chock A Ramamoorthy S Easter DW Talamini MA 《Surgical endoscopy》2008,22(8):1798-1802
Background The indications for natural orifice translumenal surgery (NOTES) are yet to be determined. Morbidly obese patients may be
one population that would benefit from this approach due to the elimination of wound complications and possibly a faster recovery.
As a bariatric restrictive procedure, sleeve gastrectomy could be one indication for NOTES. To test the feasibility of this
procedure with a NOTES approach, a pig model was used.
Methods Acute studies investigated five 40-kg farm pigs. The rectum was used as the port of entry to the peritoneal cavity, and the
stomach was manipulated endoluminally using a gastroscope. Vision was acquired through a 5-mm laparoscope introduced transabdominally
(i.e. via the hybrid technique). A 10-mm incision was made on the anterior wall of the rectum and dilated to accommodate a
12-mm trocar introduced through the rectal wall into the peritoneal cavity. The greater curvature of the stomach then was
divided and detached, starting from the antrum and proceeding to the esophagogastric junction using a laparoscopic stapler.
The sleeve gastrectomy was completed by dividing the short gastric vessels with an ultrasonic scalpel. The gastric pouch then
was removed through the rectal incision.
Results A NOTES gastric sleeve resection was successfully performed in all five pigs. The technique was developed, and feasibility
was determined. After resection, the gastric remnant was inflated, with no evidence of leakage. At autopsy, intact suture
lines were noted. Closure of the rectal incision was not attempted.
Conclusion A NOTES sleeve gastrectomy is feasible in porcine animal models. The rectal port of entry allows rigid laparoscopic instruments
to be introduced into the peritoneal cavity and enables performance of gastrointestinal procedures the same as in standard
laparoscopic surgery. Extra-long instruments are necessary for dissection and division of the stomach at the esophagogastric
junction and for accessing the short gastric vessels. 相似文献
18.
Natural orifice transluminal endoscopic surgery (NOTES) as a diagnostic tool in the intensive care unit 总被引:3,自引:0,他引:3
Onders RP McGee MF Marks J Chak A Rosen MJ Ignagni A Faulx A Schomisch S Ponsky J 《Surgical endoscopy》2007,21(4):681-683
Background Autopsy studies confirm that many intensive care unit (ICU) patients die from unrecognized sources of abdominal sepsis or
ischemia. Computed tomography (CT) scans can be of limited use for these diagnoses and difficult to obtain in critically ill
patients who require significant support for transport. Bedside laparoscopy has been described but still is cumbersome to
perform. Bedside flexible endoscopy as a diagnostic tool or for placement of gastrostomy tubes is a standard ICU procedure.
Natural orifice transluminal endoscopic surgery (NOTES) can provide access to the peritoneal cavity as a bedside procedure
and may decrease the number of patients with unrecognized intra-abdominal catastrophic events.
Methods Pigs were anesthetized and peritoneal access with the flexible endoscope was obtained using a guidewire, needle knife cautery,
and balloon dilatation. The transgastric endoscope was used to explore all quadrants of the abdominal cavity. The small bowel
was visualized to complete the exploration. The transgastric access location was then managed with the use of a gastrostomy
tube. The animals were euthanized and analyzed.
Results Eight pigs were studied and complete abdominal exploration, including diaphragm visualization, was possible in all cases.
Endoscopy-guided biopsies were performed, adhesions lysed, and the gallbladder successfully drained percutaneously. The small
bowel was run successfully with percutaneous needlescopic suture graspers.
Conclusions These animal studies support the concept that NOTES, with management of the gastric opening with a gastrostomy tube, may be
another approach for finding unrecognized sources of abdominal sepsis or mesenteric ischemia in difficult ICU patients. These
encouraging results warrant a prospective human trial to assess safety and efficacy.
Presented at the Scientific Session of the Meeting of the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES),
Dallas, TX, 26–29 April 2006
Disclosure: Case Western Reserve University, University Hospitals of Cleveland, Raymond P. Onders M.D., and Anthony Ignagni have the
intellectual property of the devices used or equity in Synapse Biomedical which manufactured the diaphragm pacing technology
used in this study 相似文献
19.
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
20.
M. H. Sodergren J. Clark V. Karimyan D. James J. Teare A. Darzi G.-Z. Yang 《European Surgery》2011,43(3):153-157
BACKGROUND: As an emerging surgical paradigm, NOTES is currently performed using conventional flexible endoscopes. Gastroenterologists
are experts in handling this instrument; however, NOTES involves manipulation of the endoscope outside the lumen of the gastrointestinal
tract. Surgeons are used to operating within the spatial environment of the peritoneal cavity. The aim of this study was to
investigate whether either surgeons or gastroenterologists are superior at navigating the endoscope in a NOTES environment
using the Imperial College Natural Orifice Simulated surgical Environment (NOSsE) as an assessment tool. METHODS: Nine novices,
5 gastroenterologists and 4 laparoscopic surgeons were recruited to navigate through a series of targets in the NOSsE phantom.
End-points were time taken to complete the course and number of targets successfully visualised. RESULTS: Gastroenterologists
and surgeons completed the course faster (p < 0.001) and revealed more targets than novices (p < 0.001). Overall, surgeons completed the course in less time than gastroenterologists (mean time 228 sec vs. 134 sec; p = 0.172) and visualised more targets (mean 8.83 vs. 7.53; p = 0.217) although neither reached statistical significance. CONCLUSIONS: The results of this pilot study suggest that surgeons
are not disadvantaged when it comes to navigating an endoscope within a simulated NOTES environment compared to gastroenterologists.
Therefore, as appears to be the current practice, it is acceptable for surgical teams to perform initial NOTES studies, provided
they possess adequate skill, appropriate laboratory experience and ethical review board approval. With the evolution in surgical
tools, we are likely to see improved instrumentation to aid in navigation in NOTES. 相似文献