共查询到20条相似文献,搜索用时 31 毫秒
1.
Alyssa D. Fajardo Steven R. Hunt James W. Fleshman Matthew G. Mutch 《Surgical endoscopy》2010,24(7):1765-1765
Background
Natural orifice transluminal endoscopic surgery (NOTES), a recent development in the field of minimally invasive surgery, provides theoretical advantages over open and laparoscopic surgery. Challenges with the use of NOTES for colon resections include the need to extract a large specimen and perform an intestinal anastomosis. A transanal single-port laparoscopic proctectomy uses the potential advantages of NOTES yet provides easy specimen extraction and anastomosis. 相似文献2.
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
3.
Ana Luisa Trejos Shiva Jayaraman Rajni V. Patel Michael D. Naish Christopher M. Schlachta 《Surgical endoscopy》2011,25(1):186-192
Background
Natural orifice transluminal endoscopic surgery (NOTES) may represent the next frontier for therapeutic minimally invasive surgery; however, its feasibility is currently limited by the lack of suitable instruments. Identifying the forces required to manipulate tissue during NOTES is a necessary first step in the development of better instrumentation. 相似文献4.
Lee L. Swanstrom Eric Volckmann Eric Hungness Nathaniel J. Soper 《Surgical endoscopy》2009,23(7):1519-1525
Background Natural orifice translumenal endoscopic surgery (NOTES) has theoretical patient advantages. Because public attitude toward
NOTES will influence its adoption, this study aimed to assess patients’ opinions regarding the NOTES procedure.
Methods For this study, 192 patients were surveyed. Both NOTES and laparoscopic surgery (LS) are described together with an example
case. Presurgical patients rated the importance of various aspects of surgical procedures and their preference for cholecystectomy
via NOTES or LS.
Results Complication risks, recovery time, and postoperative pain were considered more important than cosmesis, cost, length of hospital
stay, or anesthesia type (p < 0.001). In the self-reports, 56% of the respondents preferred NOTES for their cholecystectomy and 44% chose LS. The patients
perceived NOTES as having less pain, cost, risk of complications, and recovery time but requiring more surgical skill than
open surgery or LS (p < 0.04). College-educated patients were more likely to choose NOTES, whereas patients 70 years of age or older and those
who had undergone previous flexible endoscopy were less likely to select NOTES (p < 0.04). Although 80% of the patients choosing NOTES still preferred it even if it carried a slightly greater risk than LS,
their willingness to choose NOTES decreased as complications, cost, and hospital distance increased and as surgeon experience
decreased (p < 0.001). This study had a limitation in that the survey population was from surgery clinics.
Conclusion A majority of the patients surveyed (56%) would choose NOTES for their cholecystectomy. The deciding characteristics of the
patients were more education, youth, and no previous flexible endoscopy. Procedure-related risks, pain, and recovery time
were more important than cosmesis, cost, length of hospital stay, and anesthesia type in the choice of a surgical approach.
Patients were less willing to accept NOTES as risks and costs increased and as surgeon experience and availability decreased. 相似文献
5.
Background Natural orifice translumenal endoscopic surgery (NOTES) is a term coined by a joint group of surgeons and gastroenterologists
organized by Society for American Gastrointestinal Endoscopic Surgeons (SAGES) and American Society of Gastroenterologists
(ASGE) to describe the fusion of minimally invasive surgery and interventional endoscopy.
Methods Current literature and compiled personal experience in NOTES was reviewed to provide an expert opinion on the role of NOTES
in HPB surgery.
Results The majority of experience obtained to date has been in animal models. The few human cases and clinical trials that have been
performed show excellent promising outcomes with minimal morbidity.
Discussion The merger of interventional endoscopy and minimally invasive surgery is a natural progression as we continually push the
envelope of minimally invasive surgery. Endoscopic retrograde cholangiopancreatography, biliary stents and endoscopic ultrasonography
have forever changed treatment algorithms in HPB surgery. Advancement of minimally invasive surgery to include the liver resections,
pancreatic resections and pseudocyst management has improved morbidity and become the standard of care in many cases. Continued
development of natural orifice techniques may further alter the approaches to the biliary tract, liver and pancreas. 相似文献
6.
Elie Chouillard Arnaud Dache Adriana Torcivia Nada Helmy Ivan Ruseykin Andrew Gumbs 《Surgical endoscopy》2010,24(8):1861-1865
Background
Natural orifice translumenal endoscopic surgery (NOTES) is a major conceptual change in the field of modern surgery. However, corresponding technological refinements are not yet available to fill the gap separating the current laparoscopy from the NOTES of the future. Meanwhile, “hybrid” NOTES techniques, including single-port procedures, have been increasingly reported. This report describes a technique of single-incision laparoscopic appendectomy (SILA) for selected patients with acute appendicitis. 相似文献7.
Background
Natural orifice transluminal endoscopic surgery (NOTES) is currently of major research interest as it may offer significant clinical potential for endoscopic procedures in the future. Nevertheless, many issues are still unresolved. The aim of this study is a systematic review of the literature to evaluate techniques and technologies to address the issue of achieving a secure gastric wall defect closure. 相似文献8.
Sang-Il Lee Jong-Hyun Park Chi-Woo Park Young-Ill Kim Seong-Mok Jeong Ji-Yeon Kim 《Surgical endoscopy》2010,24(10):2387-2392
Background
Natural orifice transluminal endoscopic surgery (NOTES) for bowel resection is a challenging procedure. We studied the feasibility and safety of NOTES by performing cecectomy in dogs, which is equivalent to simple bowel resection in man. 相似文献9.
Natural orifice surgery: initial clinical experience 总被引:1,自引:0,他引:1
Santiago Horgan John P. Cullen Mark A. Talamini Yoav Mintz Alberto Ferreres Garth R. Jacobsen Bryan Sandler Julie Bosia Thomas Savides David W. Easter Michelle K. Savu Sonia L. Ramamoorthy Emily Whitcomb Sanjay Agarwal Emily Lukacz Guillermo Dominguez Pedro Ferraina 《Surgical endoscopy》2009,23(7):1512-1518
Background Natural orifice translumenal endoscopic surgery (NOTES) has moved quickly from preclinical investigation to clinical implementation.
However, several major technical problems limit clinical NOTES including safe access, retraction and dissection of the gallbladder,
and clipping of key structures. This study aimed to identify challenges and develop solutions for NOTES during the initial
clinical experience.
Methods Under an Institutional Review Board (IRB)-approved protocol, patients consented to a natural orifice operation for removal
of either the gallbladder or the appendix via either the vagina or the stomach using a single umbilical trocar for safety
and assistance.
Results Nine transvaginal cholecystectomies, one transgastric appendectomy, and one transvaginal appendectomy have been completed
to date. All but one patient were discharged on postoperative day 1 as per protocol. No complications occurred.
Conclusion The limited initial evidence from this study demonstrates that NOTES is feasible and safe. The addition of an umbilical trocar
is a bridge allowing safe performance of NOTES procedures until better instruments become available. The addition of a flexible
long grasper through the vagina and a flexible operating platform through the stomach has enabled the performance of NOTES
in a safe and easily reproducible manner. The use of a uterine manipulator has facilitated visualization of the cul de sac
in women with a uterus to allow for safe transvaginal access. 相似文献
10.
经自然腔道内镜外科的发展趋势 总被引:4,自引:4,他引:0
梁平 《中华消化外科杂志》2009,8(1)
Natural orifice translumenal endoscopic surgery(NOTES)is a surgical technique which is performed with an endoscope passed through a natural orifice,and then through an internal incision in the viscera(stomach,vagina or rectum)to perform intraabdominal operations.Since the first successful transgastric appendectomy performed by Dr.Rao and Reddy in 2004,NOTES is developing rapidly.The advantages of NOTES include no injury and scar in the body surface;lower anesthesia requirements;faster recovery and shorter hospital stays;avoidance of transabdominal wound infections.NOTES can also be applied to patients who are not suitable for open surgery and lapascopic surgery.NOTES has the potential to revolutionize the field of minimally invasive surgery by eliminating abdominal incisions,however,the safety and efficacy of NOTES still needs to be investigated in lhe future. 相似文献
11.
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
12.
Natural orifice translumenal endoscopic surgery (NOTES): dissection for the critical view of safety during transcolonic cholecystectomy 总被引:1,自引:0,他引:1
Edward D. Auyang Eric S. Hungness Khashayar Vaziri John A. Martin Nathaniel J. Soper 《Surgical endoscopy》2009,23(5):1117-1118
Background Natural orifice translumenal endoscopic surgery (NOTES), an emerging field in minimally invasive surgery, is driving the development
of new technology and techniques. The NOTES approach has several proposed benefits including potentially decreased abdominal
pain, wound infections, and hernia formation [1–4]. Cholecystectomy is one of the most commonly performed NOTES procedures to date [5–7]. To perform a safe cholecystectomy and reduce potential bile duct injuries, the cystic duct and artery must first be identified.
Establishing this critical view of safety before ligation and division has been shown to reduce bile duct injuries associated
with laparoscopic cholecystectomy [8]. This video shows that the critical view of safety can be attained with endoscopic dissection.
Methods In the porcine model, transcolonic peritoneal access is gained using an endoscopic needleknife and balloon dilator. Once orientation
is established, the gallbladder is retracted using percutaneous T-tags. The cystic duct and artery bundle are identified and
then meticulously dissected using endoscopic graspers, hook cautery, biopsy forceps, and scissors. The individual cystic duct
and artery are isolated and identified, establishing the critical view of safety. Endoscopic clip ligation and division are
then performed, and the gallbladder is dissected free.
Conclusions Dissection of the critical view of safety can be performed in a completely endoscopic fashion using appropriate instrumentation.
By achieving this critical view, the incidence of biliary injury during NOTES should be minimal and similar to the incidence
of biliary injury during laparoscopic surgery. While completing this procedure, we identified several remaining technical
limitations and deficiencies. Endoscopic retraction of tissue still is challenging with currently available instrumentation.
Hemostatic endoscopic clips are not currently available for cystic artery and duct ligation. With the development of such
instruments, cholecystectomy and other NOTES procedures will become technically more feasible.
Electronic supplementary material The online version of this article (doi:) contains supplementary material, which is available to authorized users. 相似文献
13.
Background
The advancement of natural orifice translumenal endoscopic surgery (NOTES) depends on the availability of a suitable platform. A 2008 Natural Orifice Surgery Consortium for Assessment and Research (NOSCAR) Working Group identified access, navigation, maneuverability, and stability to withstand instrument forces as the essential requirements for a successful NOTES platform [1]. No single NOTES platform can adequately achieve all four of these key capabilities. In this study, the authors tested a novel flexible endoscopic robotic platform in a cadaver to determine how it performs with respect to these specific requirements. 相似文献14.
Nobutsugu Abe Hirohisa Takeuchi Hisayo Ueki Osamu Yanagida Tadahiko Masaki Toshiyuki Mori Masanori Sugiyama Yutaka Atomi 《Journal of Hepato-Biliary-Pancreatic Surgery》2009,16(5):633-638
Background and objective
The intentional puncture of the normal viscera is likely the most important issue limiting the widespread use of natural orifice translumenal endoscopic surgery (NOTES). We developed a new procedure for cholecystectomy using a flexible endoscope via a single port placed in the abdominal wall without visceral puncture (single-port endoscopic cholecystectomy; SPEC) as a bridge between laparoscopic surgery and NOTES. This study aimed to evaluate the technical feasibility of SPEC. 相似文献15.
Auyang ED Vaziri K Volckmann E Martin JA Soper NJ Hungness ES 《Surgical endoscopy》2008,22(10):2277-2278
Background Natural orifice translumenal endoscopic surgery (NOTES) is an emerging field in minimally invasive surgery that is driving
the development of new technology and techniques [1–4]. Before NOTES gains widespread popularity, it must be proven to be
a safe and efficacious technique [5]. There are several proposed benefits to the NOTES approach, including potentially decreased
abdominal pain, wound infections, and hernia formation.
Methods Currently, most investigational NOTES procedures are performed using a single transgastric, transcolonic, or transvaginal
access point to the abdomen. In order to provide greater range of motion and freedom of movement, a rendezvous procedure using
simultaneous transgastric and transcolonic approaches was used to perform a small bowel resection. This video demonstrates
a successful NOTES hybrid small bowel resection with the use of two laparoscopic ports in a cadaveric model. A powered stapling
device attached to a flexible shaft is introduced transcolonically and facilitates division and re-anastamosis of the small
bowel. A dual-channel operating endoscope introduced transgastrically allows for precise dissection and creation of enterotomies
necessary for the small bowel resection.
Conclusions While technically challenging, NOTES hybrid small bowel resection can be accomplished with specially designed instrumentation
utilizing the rendezvous technique. There are several technical limitations preventing this procedure from being completed
in a pure NOTES fashion. A safe method of creating blind enterotomies will be needed to eliminate laparoscopic visualization
of the enterotomy sites. Adequate endoscopic exposure and retraction of tissue is still difficult and currently requires percutaneous
adjuncts. New closure devices will be needed for safe and reliable NOTES enterotomy closure. With the development of such
instruments, this, as well as other NOTES procedures, will become more technically feasible.
Electronic supplementary material The online version of this article (doi:) contains supplementary material, which is available to authorized users. 相似文献
16.
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
17.
Natural orifice transluminal endoscopic surgery (NOTES) is an emerging experimental alternative to conventional surgery. NOTES eliminates abdominal incisions and incision‐related complications by combining endoscopic and laparoscopic techniques to diagnose and treat abdominal pathology. Since the first NOTES was reported by Kalloo et al. in 2004, significant achievements in the laboratory have occurred. Clinical use in humans has been limited, but several cases and one small clinical trial were published recently. As a further technical revolution in minimally invasive surgery, NOTES has the promising potential to be safer, less invasive, provide better cosmesis and possibly be more cost‐effective. The purpose of the present article was to review the development and current status of NOTES and highlight important advances associated with this innovative approach. 相似文献
18.
Andrew D. Strickland Michael G. A. Norwood Fariba Behnia-Willison Santosh A. Olakkengil Peter J. Hewett 《Surgical endoscopy》2010,24(10):2424-2431
Background
Laparoscopic and minimally invasive surgery has changed the surgical landscape irrevocably. Natural orifice translumenal endoscopic surgery (NOTES) offers the possibility of surgery without visible scars. Transvaginal entry offers potential benefits because it gains access to the peritoneal cavity without the need to open an abdominal viscus. Much of the discussion pertaining to NOTES focuses on technical and training issues, with little attention to date paid to the opinions of women. The perceptions of female health care workers and patients were sought in relation to their views on transvaginal NOTES. 相似文献19.
Natural orifice translumenal endoscopic surgery (NOTES) represents a burgeoning but still largely experimental field. Most NOTES researchers have favored transgastric and transvaginal approaches to abdominal access. For surgeries involving the upper abdominal organs, transvaginal and transanal approach promise to provide a more direct route in contrast to the often cumbersome retroflexion typically required with the transgastric approach. The potential disadvantages of the transanal route are also significant and include issues of sterility, the risk of inadvertent trauma to adjacent organs during transmural puncture, and the risk of colonic wall shearing. This article reviews early development of NOTES, the evolution of transanal access to the peritoneal cavity, highlights the various techniques that have been used for transanal access, and discusses the relative advantages and disadvantages of this approach. 相似文献
20.
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