Patient perception of natural orifice transluminal endoscopic surgery as a technique for cholecystectomy

BACKGROUND: Although the concept of natural orifice transluminal endoscopic surgery (NOTES) as a minimally invasive surgical technique is gaining increasing popularity, patient perception toward NOTES is unclear. Because cholecystectomy is the most common laparoscopic procedure, the concept of NOTES was examined in this context. AIM: To evaluate patient perception of NOTES as a potential technique for a cholecystectomy. PATIENTS: Those patients with an intact gallbladder who were undergoing an EUS or an ERCP for evaluation of abdominal pain, pancreatitis, or suspected choledocholithiasis. SETTING: Tertiary-referral center. DESIGN: Cross-sectional survey. METHODS: One hundred patients were given a questionnaire that described the technique, the complication rates, and benefits of laparoscopic cholecystectomy (LC). The concept of NOTES was then described in detail, with possible orifices being the mouth, the rectum, and the vagina. Patients were queried about their preference for a cholecystectomy technique (LC vs NOTES), choice of orifice, and the risks that they were willing to undergo for NOTES. RESULTS: Of the 100 patients, 78% preferred NOTES, and 22% preferred LC. The mean age of the patients was 45 years; 36% of patients were men, 70% were white, and 83% had undergone a prior endoscopy; no significant differences were observed between the NOTES and LC groups for these characteristics. In multivariable modeling, those with age 相似文献   

A self-approximating transluminal access technique for potential use in NOTES: an ex vivo porcine model (with video)

BACKGROUND: NOTES (natural orifice transluminal endoscopic surgery) is an area of active research in experimental endoscopy and has the potential to significantly advance the field of minimally invasive surgery. Several investigators have illustrated the need for a transluminal access technique that is safe, reliable, and reproducible. Currently used methods directly cut through the organ wall into the peritoneum; however, rare difficulty in closing the defect with negative outcomes have been described. OBJECTIVE: To evaluate an alternative method for transluminal access. DESIGN: An ex vivo, experimental endoscopy study. SETTING: Penn State Hershey Medical Center, Animal Research Laboratories. METHODS: By using ex vivo porcine esophagus, stomach, and colon, a submucosal tunnel was created as a means of physically separating the lumen from the peritoneum during transluminal access. Postprocedure leak testing was performed, and all procedures were video recorded. RESULTS: Results of the self-approximating transluminal access technique (STAT) in porcine esophagus and stomach demonstrated the technical feasibility of this approach. The STAT was not felt to be feasible in the porcine colon. LIMITATIONS: This investigation was a limited, ex vivo pilot study and will require further testing in an adequate number of live animals. CONCLUSIONS: The STAT is technically feasible in porcine esophagus and stomach, and may have advantages over currently used techniques.     

NOTES瘘口闭合技术的研究及应用

正在兴起的经自然腔道内镜外科(NOTES)是一门基于微创新理念、多学科交叉的内镜治疗新技术。过去数年来尽管人们在NOTES领域进行了大量努力和探索,但似乎NOTES由动物实验转向大规模临床应用仍有很长的路要走,且有很多技术问题需要解决。在所有NOTES未解决的技术难题中,可靠的内脏瘘口闭合技术必须优先解决。本文,我们将对NOTES瘘口闭合方面的努力和进展进行回顾和述评。     

Transvaginal natural orifice transluminal endoscopic surgery in the diagnosis of ascites of unknown origin

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