| Abstract: | Background and Objectives:The optimal access route and method for natural orifice transluminal endoscopic surgery
(NOTES) has not been established. A transvesical approach, with its low rate of
peritoneal contamination, is an effective clean portal of entry, but a safe urinary
bladder closure has been a challenge. We developed a new technique for a safe, pure
transvesical NOTES approach.Methods:Four female piglets were used in the study. With the pigs under anesthesia, a flexible
cystoscope (15Fr) was used to make an endoscopic cystotomy; diagnostic peritoneoscopy of
the abdominal quadrants was done with biopsies and hemostasis. At the end, a Vicryl loop
was pushed to close the bladder incision while the incision edges were pulled inwards.
The pigs were euthanized after 2 wk, and necropsies were performed.Results:No bowel injury was noted in any of the 4 pigs. Satisfactory bladder closure was done
in 2 pigs, while a partial closure was achieved in 1 case. In the postoperative period,
the pigs showed no signs of pain or distress, voided normally, and had a good appetite.
On necropsy, we noted healed cystotomy incisions, no intraabdominal adhesions, and no
adhesions at the site.Conclusion:Our new technique for endoscopic cystotomy overcomes previously reported risks for
bowel injuries. Using this route gives good spatial orientation and access to all
quadrants, including the pelvis. Biopsies with good hemostasis can be easily achieved.
Lack of intraperitoneal changes postoperatively indicate that this procedure may be safe
for humans. |
