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Hatai S, Nagai S, Yoshida T, Matsuoka M, Shinkawa T, Oyama Y, Tanabe Y, Kitahara D, Tamiya S, Amada S, Nishihara K, Nakano T. Transvaginal resection of a gastrointestinal stromal tumor of the rectum: a case report. Surg Case Rep 2024; 10:150. [PMID: 38886293 PMCID: PMC11183011 DOI: 10.1186/s40792-024-01949-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Accepted: 06/11/2024] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND The most common curative treatment for gastrointestinal stromal tumors (GISTs) is local excision. For rectal GISTs, however, local excision is difficult because of the anatomical features of the rectum. The optimal surgical approach is still under debate, and less invasive methods are desired. We herein report a case of transvaginal resection of a rectal GIST in a young woman. CASE PRESENTATION A 21-year-old woman was diagnosed with a resectable GIST in the anterior rectal wall and underwent transvaginal tumor resection. The posterior vaginal wall was incised, revealing the tumor fully covered by the rectal mucosa. The rectal adventitia and muscular layer were incised, and the tumor was resected en bloc without rupture. The postoperative course was favorable, and the patient was discharged on postoperative day 12. No findings consistent with recurrence were present 6 months postoperatively. CONCLUSION Transvaginal tumor resection is a treatment option as a minimally invasive procedure for GISTs in the anterior rectal wall in female patients.
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Affiliation(s)
- Sanshiro Hatai
- Department of Surgery, Kitakyushu Municipal Medical Center, 2-1-1 Basyaku, Kokurakita-Ku, Kitakyushu, Fukuoka, 802-0077, Japan
| | - Shuntaro Nagai
- Department of Surgery, Kitakyushu Municipal Medical Center, 2-1-1 Basyaku, Kokurakita-Ku, Kitakyushu, Fukuoka, 802-0077, Japan.
| | - Taiki Yoshida
- Department of Surgery, Kitakyushu Municipal Medical Center, 2-1-1 Basyaku, Kokurakita-Ku, Kitakyushu, Fukuoka, 802-0077, Japan
| | - Masaru Matsuoka
- Department of Surgery, Kitakyushu Municipal Medical Center, 2-1-1 Basyaku, Kokurakita-Ku, Kitakyushu, Fukuoka, 802-0077, Japan
| | - Tomohiko Shinkawa
- Department of Surgery, Kitakyushu Municipal Medical Center, 2-1-1 Basyaku, Kokurakita-Ku, Kitakyushu, Fukuoka, 802-0077, Japan
| | - Yasuhiro Oyama
- Department of Surgery, Kitakyushu Municipal Medical Center, 2-1-1 Basyaku, Kokurakita-Ku, Kitakyushu, Fukuoka, 802-0077, Japan
| | - Yoshitaka Tanabe
- Department of Surgery, Kitakyushu Municipal Medical Center, 2-1-1 Basyaku, Kokurakita-Ku, Kitakyushu, Fukuoka, 802-0077, Japan
| | - Daichi Kitahara
- Department of Pathology, Kitakyushu Municipal Medical Center, Fukuoka, Japan
| | - Sadafumi Tamiya
- Department of Pathology, Kitakyushu Municipal Medical Center, Fukuoka, Japan
| | - Satoshi Amada
- Department of Obstetrics and Gynecology, Kitakyushu Municipal Medical Center, Fukuoka, Japan
| | - Kazuyoshi Nishihara
- Department of Surgery, Kitakyushu Municipal Medical Center, 2-1-1 Basyaku, Kokurakita-Ku, Kitakyushu, Fukuoka, 802-0077, Japan
| | - Toru Nakano
- Department of Surgery, Kitakyushu Municipal Medical Center, 2-1-1 Basyaku, Kokurakita-Ku, Kitakyushu, Fukuoka, 802-0077, Japan
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Ishii M, Nitta T, Kataoka J, Ueda Y, Matsutani A, Taki M, Kubo R, Ota M, Ishibashi T. IRIS U kit usefulness in transanal total mesorectal excision for lower rectal cancer to avoid urethral injury. BMC Gastroenterol 2024; 24:203. [PMID: 38886646 PMCID: PMC11181656 DOI: 10.1186/s12876-024-03279-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Accepted: 05/31/2024] [Indexed: 06/20/2024] Open
Abstract
Transanal total mesorectal excision (taTME) has improved the laparoscopic dissection for rectal cancer in the narrow pelvis. Although taTME has more clinical benefits than laparoscopic surgery, such as a better view of the distal rectum and direct determination of distal resection margin, an intraoperative urethral injury could occur in excision ta-TME. This study aimed to determine the feasibility and efficacy of the ta-TME with IRIS U kit surgery. This retrospective study enrolled 10 rectal cancer patients who underwent a taTME with an IRIS U kit. The study endpoints were the safety of access (intra- or postoperative morbidity). The detectability of the IRIS U kit catheter was investigated by using a laparoscope-ICG fluorescence camera system. Their mean age was 71.4±6.4 (58-78) years; 80 were men, and 2 were women. The mean operative time was 534.6 ± 94.5 min. The coloanal anastomosis was performed in 80%, and 20% underwent abdominal peritoneal resection. Two patients encountered postoperative complications graded as Clavien-Dindo grade 2. The transanal approach with IRIS U kit assistance is feasible, safe for patients with lower rectal cancer, and may prevent intraoperative urethral injury.
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Affiliation(s)
- Masatsugu Ishii
- Division of Surgery Gastroenterological Center, Medico Shunju Shiroyama Hospital, 2-8-1 Habikino, Habikino, Osaka, 583-0872, Japan.
| | - Toshikatsu Nitta
- Division of Surgery Gastroenterological Center, Medico Shunju Shiroyama Hospital, 2-8-1 Habikino, Habikino, Osaka, 583-0872, Japan
| | - Jun Kataoka
- The Department of Colorectal Surgery, National Cancer Center Hospital East, Kashiwa, Japan
| | - Yasuhiko Ueda
- Division of Surgery Gastroenterological Center, Medico Shunju Shiroyama Hospital, 2-8-1 Habikino, Habikino, Osaka, 583-0872, Japan
| | - Ayumi Matsutani
- Division of Surgery Gastroenterological Center, Medico Shunju Shiroyama Hospital, 2-8-1 Habikino, Habikino, Osaka, 583-0872, Japan
| | - Masataka Taki
- Division of Surgery Gastroenterological Center, Medico Shunju Shiroyama Hospital, 2-8-1 Habikino, Habikino, Osaka, 583-0872, Japan
| | - Ryutaro Kubo
- Division of Surgery Gastroenterological Center, Medico Shunju Shiroyama Hospital, 2-8-1 Habikino, Habikino, Osaka, 583-0872, Japan
| | - Masato Ota
- Division of Surgery Gastroenterological Center, Medico Shunju Shiroyama Hospital, 2-8-1 Habikino, Habikino, Osaka, 583-0872, Japan
| | - Takashi Ishibashi
- Division of Surgery Gastroenterological Center, Medico Shunju Shiroyama Hospital, 2-8-1 Habikino, Habikino, Osaka, 583-0872, Japan
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3
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Echevarria S, Rauf F, Hussain N, Zaka H, Farwa UE, Ahsan N, Broomfield A, Akbar A, Khawaja UA. Typical and Atypical Presentations of Appendicitis and Their Implications for Diagnosis and Treatment: A Literature Review. Cureus 2023; 15:e37024. [PMID: 37143626 PMCID: PMC10152406 DOI: 10.7759/cureus.37024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2023] [Indexed: 05/06/2023] Open
Abstract
Appendicitis, an acute inflammation of the appendix, affects all demographic groups and exhibits various incidences and clinical manifestations. While acute appendicitis typically presents with colicky periumbilical abdominal pain that localizes to the right lower quadrant, atypical presentations are more common in children, geriatric, and pregnant patient populations, leading to delays in diagnosis. Clinical evaluation, clinical scoring systems, and inflammatory markers are commonly used, but their limitations have led to the increased use of diagnostic imaging in patients suspected of appendicitis. Acute appendicitis is managed by non-operative and operative management, depending on whether it is uncomplicated or complicated. Developing diagnostic pathways to improve outcomes and reduce complications is crucial. Although medical advancements have been made, diagnosing and managing appendicitis can be challenging, mainly when patients are present atypically. This literature review aims to comprehensively review typical and atypical presentations of appendicitis and their current implications for diagnosis and treatment modalities in pediatric, adult, pregnant, and geriatric patient populations.
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Affiliation(s)
| | - Fatima Rauf
- Internal Medicine, Rawalpindi Medical University, Rawalpindi, PAK
| | - Nabeel Hussain
- Internal Medicine, Saba University School-Medicine, Devens, USA
| | - Hira Zaka
- Neurosurgery, Jinnah Postgraduate Medical Centre, Karachi, PAK
| | - Umm-E- Farwa
- Surgery, Jinnah Sindh Medical University, Karachi, PAK
| | - Nayab Ahsan
- Internal Medicine, Quaid-e-Azam Medical College, Bahawalpur, PAK
| | - Alison Broomfield
- Family Medicine, Spartan Health Sciences University, Vieux Fort, LCA
| | - Anum Akbar
- Pediatrics, University of Nebraska Medical Center, Omaha, USA
| | - Uzzam Ahmed Khawaja
- Pulmonary and Critical Care Medicine, Jinnah Medical and Dental College, Karachi, PAK
- Clinical and Translational Research, Dr Ferrer BioPharma, South Miami, USA
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4
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Kisby CK, Kelley SR, Linder BJ. Management of advanced prolapse including a bowel obstruction: expanding the role of transvaginal surgery. Int Urogynecol J 2021; 33:153-155. [PMID: 34851440 DOI: 10.1007/s00192-021-05027-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 10/30/2021] [Indexed: 11/27/2022]
Abstract
INTRODUCTION AND HYPOTHESIS We reviewed a case of concomitant advanced pelvic organ prolapse and partial small bowel obstruction managed via transvaginal small bowel resection and native tissue prolapse repair. METHODS The patient is an 82-year-old woman with a history of a radical cystectomy and ileal conduit 2 years prior for bladder cancer that was transferred from an outside hospital for incarcerated prolapse including a small bowel obstruction with transition point inside the prolapse. She had previously unsuccessfully tried several pessaries for her prolapse. She was widowed and not sexually active. After conservative management of her bowel obstruction was unsuccessful, she was taken to the operating room for transvaginal prolapse repair. Intraoperatively, we encountered an isolated area of indurated bowel adherent to the prolapse. Colorectal surgery performed a transvaginal small bowel resection with stapled anastomosis, and a modified LeFort colpocleisis was performed to address her prolapse. Her postoperative course was uncomplicated, and at 6 months, she reported normal bowel function and had no evidence of prolapse recurrence. CONCLUSION We present a case of incidental bowel pathology during vaginal prolapse surgery, requiring a small bowel resection. This case demonstrates the feasibility of this procedure when working with a multi-disciplinary team and localized bowel pathology.
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Affiliation(s)
- Cassandra K Kisby
- Department of Obstetrics/Gynecology, Duke University Medical Center, 201 Trent Dr., Baker House 203, Durham, NC, 27710, USA.
| | - Scott R Kelley
- Division of Colorectal Surgery, Mayo Clinic, Rochester, MN, USA
| | - Brian J Linder
- Department of Urology, Mayo Clinic, Rochester, MN, USA
- Department of Obstetrics/Gynecology, Mayo Clinic, Rochester, MN, USA
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5
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Zhao LX, Liu ZZ, Ullah S, Liu D, Yang HY, Liu BR. The detachable balloon: A novel device for safe trans-rectal natural orifice transluminal endoscopic surgery. Dig Liver Dis 2021; 53:931-934. [PMID: 33994130 DOI: 10.1016/j.dld.2021.04.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 04/16/2021] [Accepted: 04/19/2021] [Indexed: 12/11/2022]
Affiliation(s)
- Li-Xia Zhao
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Zhengzhou University, No. 1 Eastern Jianshe Road, Zhengzhou 450052, PR China
| | - Zhen-Zhen Liu
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Zhengzhou University, No. 1 Eastern Jianshe Road, Zhengzhou 450052, PR China
| | - Saif Ullah
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Zhengzhou University, No. 1 Eastern Jianshe Road, Zhengzhou 450052, PR China
| | - Dan Liu
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Zhengzhou University, No. 1 Eastern Jianshe Road, Zhengzhou 450052, PR China
| | - Hui-Yu Yang
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Zhengzhou University, No. 1 Eastern Jianshe Road, Zhengzhou 450052, PR China
| | - Bing-Rong Liu
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Zhengzhou University, No. 1 Eastern Jianshe Road, Zhengzhou 450052, PR China.
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6
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Shanbhag AB, Thota PN, Sanaka MR. Recent advances in third space or intramural endoscopy. World J Gastrointest Endosc 2020; 12:521-531. [PMID: 33362905 PMCID: PMC7739143 DOI: 10.4253/wjge.v12.i12.521] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 10/18/2020] [Accepted: 11/29/2020] [Indexed: 02/06/2023] Open
Abstract
Third space endoscopy or intramural endoscopy is based on the principle that the deeper layers of the gastrointestinal tract can be accessed by tunneling in the submucosal space and maintaining the integrity of the overlying mucosa. The era of third space endoscopy started with peroral endoscopic myotomy (POEM) for treatment of achalasia and has expanded to treat various other gastrointestinal disorders. The technique is also currently used for treatment of refractory gastroparesis, Zenker’s diverticulum (ZD), resection of subepithelial tumors and early cancers of the gastrointestinal tract and Hirschsprung’s disease (HD). These procedures are rapidly emerging as minimally invasive alternatives to conventional surgery. They are safe and effective with excellent outcomes. This review focuses on the evolution and current applications of third space endoscopy in various gastrointestinal disorders. Key points: (1) Third space or intramural endoscopy initially started with the POEM procedure for treatment of achalasia; (2) Advancements in procedural techniques have expanded its application to treat other gastrointestinal disorders such as refractory gastroparesis, ZD, HD, resection of subepithelial tumors and early gastrointestinal cancers; (3) These procedures are highly effective with excellent outcomes and low complication rates; and (4) Third space endoscopic procedures are rapidly emerging as minimally invasive alternatives to conventional surgery.
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Affiliation(s)
- Akshay B Shanbhag
- Department of Gastroenterology, Cleveland Clinic Foundation, Cleveland, OH 44195, United States
| | - Prashanthi N Thota
- Department of Gastroenterology, Cleveland Clinic Foundation, Cleveland, OH 44195, United States
| | - Madhusudhan R Sanaka
- Department of Gastroenterology, Cleveland Clinic Foundation, Cleveland, OH 44195, United States
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7
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Advances and Trends in Pediatric Minimally Invasive Surgery. J Clin Med 2020; 9:jcm9123999. [PMID: 33321836 PMCID: PMC7764454 DOI: 10.3390/jcm9123999] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 11/28/2020] [Accepted: 12/03/2020] [Indexed: 12/11/2022] Open
Abstract
As many meta-analyses comparing pediatric minimally invasive to open surgery can be found in the literature, the aim of this review is to summarize the current state of minimally invasive pediatric surgery and specifically focus on the trends and developments which we expect in the upcoming years. Print and electronic databases were systematically searched for specific keywords, and cross-link searches with references found in the literature were added. Full-text articles were obtained, and eligibility criteria were applied independently. Pediatric minimally invasive surgery is a wide field, ranging from minimally invasive fetal surgery over microlaparoscopy in newborns to robotic surgery in adolescents. New techniques and devices, like natural orifice transluminal endoscopic surgery (NOTES), single-incision and endoscopic surgery, as well as the artificial uterus as a backup for surgery in preterm fetuses, all contribute to the development of less invasive procedures for children. In spite of all promising technical developments which will definitely change the way pediatric surgeons will perform minimally invasive procedures in the upcoming years, one must bear in mind that only hard data of prospective randomized controlled and double-blind trials can validate whether these techniques and devices really improve the surgical outcome of our patients.
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8
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Jategaonkar PA, Yadav SP, Gupta D. Transvaginal laparoscopic appendectomy using innovative submucosal tunnels: a conducive modification for improving hybrid NOTES access and its critical appraisal. Trop Doct 2020; 50:209-215. [DOI: 10.1177/0049475520921277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Currently, transvaginal natural orifice transluminal endoscopic surgery (NOTES), the most minimally invasive option for laparoscopic surgery, suffers various technological restraints limiting its implementation. We discuss a simple modification for vaginal access to improve the existing hybrid NOTES technique. We retrospectively studied 18 women at our rural hospital in central India, who, under defined criteria, underwent transvaginal appendicectomy using innovative strategically designed submucosal tunnels. The procedure was successfully completed in all but the first three cases. None required additional abdominal trocar or analgesia beyond the first 6 h. The mean operative and hospitalisation times were 27.5 min and 18.5 h, respectively. We had no intraoperative complications and only one patient experienced postoperative self-limiting vaginal spotting. All patients were very pleased with the cosmetic results and sexual life as assessed by locally devised scales. On regular follow-up, all were progressing well. We recommend the method presented, as it is not only feasible and safe but has the potential to improve overall results. Clearly, a larger volume randomised trial would be optimal to confirm our conclusion.
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Affiliation(s)
- Priyadarshan A Jategaonkar
- Professor of Surgery, Surgical Gastroenterologist and Advance Laparoscopic Surgeon, Department of Surgery, Division of GI & Minimal Access Surgery, Mahatma Gandhi Institute of Medical Sciences, Wardha, Maharashtra, India
| | - Sudeep P Yadav
- Senior Resident, Department of Plastic & Reconstructive Surgery, Grant’s Government Medical College and Sir JJ Group of Hospitals, Mumbai, Maharashtra, India
| | - Dilip Gupta
- Director, Professor and Head, Department of Surgery, Mahatma Gandhi Institute of Medical Sciences, Wardha, Maharashtra, India
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9
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Zapico Á, Couso A, Valenzuela P, Fuentes P. Cirugía oncológica ginecológica mediante puerto único y endoscopia operatoria por orificios naturales empleando equipamiento convencional. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2018. [DOI: 10.1016/j.gine.2017.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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10
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Study protocol for a multicenter prospective controlled and randomized trial of transanal total mesorectal excision versus laparoscopic low anterior resection in rectal cancer. Int J Colorectal Dis 2018; 33:649-655. [PMID: 29546560 DOI: 10.1007/s00384-018-2996-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/26/2018] [Indexed: 02/07/2023]
Abstract
PURPOSE Compared with the open approach, laparoscopic total mesorectal excision (TME) achieves faster patient recovery, reduces morbidity rates, and shortens hospital stay. However, in laparoscopic low anterior resection (L-LAR), conversion to open surgery is required in almost 20% of cases. Transanal TME (Ta-TME) combined with laparoscopy, also called hybrid natural orifice transluminal endoscopic surgery (NOTES), is a less invasive procedure that can overcome some of the limitations of laparoscopic rectal surgery. In this study, we aim to determine whether Ta-TME has a lower rate of conversion to open surgery than L-LAR, and thus achieves faster patient recovery without altering the pathological, functional, or oncological results. The main objective is to compare the results for conversion to open surgery between Ta-TME and L-LAR. METHODS Multicenter, prospective randomized controlled study of patients diagnosed with rectal adenocarcinoma who will be randomly allocated to Ta-TME or L-LAR groups after the application of inclusion and exclusion criteria. The main endpoint is conversion to open surgery and the secondary endpoints are general morbidity and mortality and hospital stay. Demographic, surgical, and pathological variables will also be studied, along with quality of life and survival. A sample size of 53 patients per group is calculated. With an estimated loss of 10%, the final sample required will be 116 patients. CONCLUSIONS Ta-TME achieves a lower conversion rate to open surgery than L-LAR, thus improving patient recovery and reducing overall morbidity. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02550769. Registration no. Ethical and Clinical Research Committee, Parc Taulí University Hospital: ID 2014/064.
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11
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Oliveira ALA, Zorron R, Oliveira FMMDE, Santos MBD, Scheffer JP, Rios M, Antunes F. Transcolonic Perirectal NOTES Access (PNA): A feasibility study with survival in swine model. AN ACAD BRAS CIENC 2018; 89:685-693. [PMID: 28562823 DOI: 10.1590/0001-3765201720160541] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 01/23/2017] [Indexed: 12/22/2022] Open
Abstract
Transrectal access still has some unsolved issues such as spatial orientation, infection, access and site closure. This study presents a simple technique to perform transcolonic access with survival in a swine model series. A new technique for NOTES perirectal access to perform retroperitoneoscopy, peritoneoscopy, liver and lymphnode biopsies was performed in 6 pigs, using Totally NOTES technique. The specimens were extracted transanally. The flexible endoscope was inserted through a posterior transmural incision and the retrorectal space. Cultures of bacteria were documented for the retroperitoneal space and intra abdominal cavity after 14 days. Rectal site was closed using non-absorbable sutures. There was no bowel cleansing, nor preoperative fasting. The procedures were performed in 6 pigs through transcolonic natural orifice access using available endoscopic flexible instruments. All animals survived 14 days without complications, and cultures were negative. Histopathologic examination of the rectal closure site showed adequate healing of suture line and no micro abscesses. The results of feasibility and safety of experimental Transcolonic NOTES potentially brings new frontiers and future wider applications for minimally invasive surgery. The treatment of colorectal, abdominal and retroperitoneal diseases through a flexible Perirectal NOTES Access (PNA) is a promising new approach.
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Affiliation(s)
- André L A Oliveira
- Departamento de Cirurgia Veterinária, Universidade Estadual do Norte Fluminense, Campos dos Goytacazes, RJ, Brazil
| | | | | | - Marcelo B Dos Santos
- Departamento de Cirurgia Veterinária, Universidade Estadual do Norte Fluminense, Campos dos Goytacazes, RJ, Brazil
| | - Jussara P Scheffer
- Departamento de Cirurgia Veterinária, Universidade Estadual do Norte Fluminense, Campos dos Goytacazes, RJ, Brazil
| | - Marcelo Rios
- Clínica Veterinária-Gávea, Rio de Janeiro, RJ, Brazil
| | - Fernanda Antunes
- Departamento de Cirurgia Veterinária, Universidade Estadual do Norte Fluminense, Campos dos Goytacazes, RJ, Brazil
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12
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Shussman N, Appelbaum L, Marom G, Luques L, Elazary R, Abu-Gazala M, Pikarsky AJ, Mintz Y. Changes in abdominal wall thickness during laparoscopy: implications for the use of magnetic assisted surgery. MINIM INVASIV THER 2018; 27:321-326. [DOI: 10.1080/13645706.2018.1457543] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Affiliation(s)
- Noam Shussman
- Department of General Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Liat Appelbaum
- Diagnostic and Interventional Ultrasound Unit, Department of Radiology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Gad Marom
- Department of General Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Lisandro Luques
- Department of General Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Ram Elazary
- Department of General Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Mahmoud Abu-Gazala
- Department of General Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Alon J. Pikarsky
- Department of General Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Yoav Mintz
- Department of General Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
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13
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Patrascu S, Copaescu CA, Surlin V, Ramboiu S, Dragoescu AN, Stanilescu S, Cristian D, Ungureanu BS, Burtea DE, Patrascu AM, Turcu F, Saftoiu A. Intraoperative cardiovascular response of natural orifice transluminal endoscopic surgery versus laparoscopy: A comparative animal study. J Minim Access Surg 2018; 14:316-320. [PMID: 29319013 PMCID: PMC6130180 DOI: 10.4103/jmas.jmas_121_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background: Natural orifice transluminal endoscopic surgery (NOTES) emerged as a new alternative method in minimally invasive techniques. Although a very small number of studies have compared the physiologic response in NOTES to laparoscopy, the results remain controversial. Aim: This experimental animal study aims to evaluate the intraoperative cardiovascular and respiratory effects of pure transluminal natural orifice surgery and conventional laparoscopy. Materials and Methods: Twenty female pigs (Sus scrofa domesticus) equally divided into two study groups were assigned to either pure natural orifice transluminal endoscopic techniques (Group 1) or conventional laparoscopic surgery (Group 2) and monitored intraoperatively in terms of heart rate (HR), systolic blood pressure (SBP) and O2 saturation (SpO2) for 1 h. Both groups underwent simple surgical procedures such as gastrojejunostomy, oophorectomy and adnexectomy. Results: All procedures were successfully completed. The findings indicated statistically significant differences between SBP (P = 0.0065) and SpO2 (P = 0.027) in the two groups at the beginning of the interventions. HR showed significant differences during the last 20 min of the interventions (min 40 and 45; P < 0.001). For the whole procedure (from the beginning of the intervention to 60 min interval), HR, SBP and SpO2 values showed no statistical difference. Conclusions: Although significant differences in terms of HR, mean blood pressure and SpO2 were noted at specific intervals during surgery, no real variance of the cardiovascular parameters was observed when considering the entire procedure. Therefore, NOTES seems to be a safe approach with minimally intraoperative cardiovascular and respiratory implications.
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Affiliation(s)
- Stefan Patrascu
- Department of Surgery, University of Medicine and Pharmacy of Craiova, Craiova, Romania
| | - Catalin Andu Copaescu
- Center of Excellence in Bariatric and Metabolic Surgery, Regina Maria Ponderas Academic Hospital, Bucharest, Romania
| | - Valeriu Surlin
- Department of Surgery, University of Medicine and Pharmacy of Craiova, Craiova, Romania
| | - Sandu Ramboiu
- Department of Surgery, University of Medicine and Pharmacy of Craiova, Craiova, Romania
| | | | | | - Dan Cristian
- Department of Surgery, Coltea Hospital, Bucharest, Romania
| | - Bogdan Silviu Ungureanu
- Department of Research Center in Gastroenterology and Hepatology, University of Medicine and Pharmacy of Craiova, Craiova, Romania
| | - Daniela Elena Burtea
- Department of Research Center in Gastroenterology and Hepatology, University of Medicine and Pharmacy of Craiova, Craiova, Romania
| | - Ana Maria Patrascu
- Department of Hematology, University of Medicine and Pharmacy of Craiova, Craiova, Romania
| | - Florin Turcu
- Center of Excellence in Bariatric and Metabolic Surgery, Regina Maria Ponderas Academic Hospital, Bucharest, Romania
| | - Adrian Saftoiu
- Department of Research Center in Gastroenterology and Hepatology, University of Medicine and Pharmacy of Craiova, Craiova, Romania
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14
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Abstract
PURPOSE OF REVIEW The recent developments and clinical applications of natural orifice translumenal endoscopic surgery (NOTES)-procedures and technologies are going to be presented. RECENT FINDINGS In experimental as well as clinical settings, NOTES-procedures are predominantly performed in hybrid technique. Current experimental studies focus on the implementation of new surgical approaches as well as on the training of procedures. One emphasis in the clinical application is transrectal and transanal interventions. Transanal total mesorectal excision is equivalent to laparoscopic procedures but with the benefit of an even less invasive access. Transvaginal cholecystectomy can achieve results that are comparable to surgeries that are performed with laparoscopic techniques alone. An analysis of the German NOTES-Register concerning appendectomies as well as the national performance of NOTES-interventions in Switzerland is presented. Apart from intraabdominal approaches, several centers proclaim transoral thyroidectomies and transoral mediastinoscopies. SUMMARY NOTES-procedures are performed in animal experiments as well as in clinical setting although with less frequency. At this time, hybrid techniques using rigid instruments are mainly applied.
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Isaac-Lowry OJ, Okamoto S, Pedram SA, Woo R, Berkelman P. Compact teleoperated laparoendoscopic single-site robotic surgical system: Kinematics, control, and operation. Int J Med Robot 2017; 13. [PMID: 28345294 DOI: 10.1002/rcs.1811] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 12/26/2016] [Accepted: 12/30/2016] [Indexed: 11/08/2022]
Abstract
BACKGROUND To date a variety of teleoperated surgical robotic systems have been developed to improve a surgeon's ability to perform demanding single-port procedures. However typical large systems are bulky, expensive, and afford limited angular motion, while smaller designs suffer complications arising from limited motion range, speed, and force generation. This work was to develop and validate a simple, compact, low cost single site teleoperated laparoendoscopic surgical robotic system, with demonstrated capability to carry out basic surgical procedures. METHODS This system builds upon previous work done at the University of Hawaii at Manoa and includes instrument and endoscope manipulators as well as compact articulated instruments designed to overcome single incision geometry complications. A robotic endoscope holder was used for the base, with an added support frame for teleoperated manipulators and instruments fabricated mostly from 3D printed parts. Kinematics and control methods were formulated for the novel manipulator configuration. RESULTS Trajectory following results from an optical motion tracker and sample task performance results are presented. CONCLUSIONS Results indicate that the system has successfully met the goal of basic surgical functionality while minimizing physical size, complexity, and cost.
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Affiliation(s)
| | - Steele Okamoto
- Department of Mechanical Engineering, University of Hawaii at Manoa, USA
| | | | - Russell Woo
- Department of Mechanical Engineering, University of Hawaii at Manoa, USA
| | - Peter Berkelman
- Department of Mechanical Engineering, University of Hawaii at Manoa, USA
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Khan AQ, Liu E, Li P, Gul H, Fokeerchand J, Niu J, Niu W. Transvaginal Laparoscopically Assisted Endoscopic Appendectomy: a major Hybrid Natural Orifice Transluminal Endoscopic Surgery case series in Asia. Int Surg 2016; 101:153-160. [PMID: 26998935 DOI: 10.9738/intsurg-d-16-00003.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Evaluation of a Hybrid Approach to NOTES and its performance relative to conventional procedures. BACKGROUND Globally, numerous institutions have successfully implemented minimally invasive surgeries by applying natural orifice translumenal endoscopic surgery (NOTES) techniques and achieved decreased morbidity while performing incision-less surgery. However, these techniques are still not common in surgical practice in China and Pakistan. Documenting the experiences and challenges encountered in implementing NOTES in such environments can provide guidance for NOTES implementation elsewhere. METHODS From May 2010 to April 2012, 16 human transvaginal appendectomies were carried out applying a hybrid NOTES technique using a solo-umbilical trocar, which provided a safe access for laparoscopic assistance during surgical procedure. After removal of the appendix transvaginally, the colpotomy was sutured under direct vision with absorbable stitches. The outcomes of cases treated with hybrid NOTES techniques were compared to those of conventional laparoscopic appendectomy. RESULTS All patients underwent a successful surgical procedure with no intra- or post-operative complications and provided no specific complaints during the tenth day and a monthly follow-up for 2 years. The patients convalesced promptly with healthy and satisfactory cosmetic results. Compared to conventional laparoscopic appendectomy, the hybrid NOTES operation had less post-operative pain, lower cost, and shorter hospitalization. CONCLUSIONS Hybrid NOTES procedures can be performed safely using a solo-umbilical trocar. Our initial experience reveals that this hybrid technique is practically feasible and associated with minimal post-operative pain, reasonable convalescence time, and improved cosmetic outcomes.
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Affiliation(s)
| | | | | | | | | | - Jun Niu
- 1 Laparoscopic Minimally Invasive Surgery of Shandong University
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Caetano Júnior EM, Vieira JP, Moura-Franco RMAM, Fuziy RA, Serra HO, Marcondes GB, Shiraiwa DK, Sousa MGD, Girão MJBC, Lopes-Filho GDJ, Linhares MM. Evaluation of systemic inflammatory responses in cholecystectomy by means of access. Single-port umbilical incision, transvaginal NOTES, laparoscopy and laparotomy. Acta Cir Bras 2015; 30:691-703. [PMID: 26560428 DOI: 10.1590/s0102-86502015010000000] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Accepted: 09/14/2015] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To evaluate and compare clinical and inflammatory responses to the surgical trauma caused by cholecystectomy via several access approaches: single-port umbilical incision (SILS), transvaginal natural orifice transluminal endoscopic surgery (NOTES), laparoscopy, and Laparotomy. METHODS Twenty-eight female pigs were equally divided into four groups and submitted to cholecystectomy by single-port umbilical incision, transvaginal NOTES, laparoscopy, or Laparotomy. An additional five animals served as controls (sham group). Animals were monitored perioperatively regarding anesthesia and surgical procedure times, as well as for the presence of complications. Postoperatively, they were evaluated regarding time to ambulation and feeding, and the presence of clinical events. Procalcitonin, C-reactive protein (CRP), and AQUI feron-gamma (IFN-γ) measurements were performed before surgery and immediately, two days, and seven days after surgery. Animals were sacrificed and necropsied at seven days after surgery. RESULTS All procedures were successfully performed as proposed in each group. Only minor complications, such as gallbladder perforation and bleeding from the liver bed, were observed during surgery in all groups. The vaginal NOTES group showed higher anesthesia and surgical procedure times compared to the other groups (p<0.001). No other between-group differences in perioperative or postoperative times, clinical evolution, or serum inflammatory markers were observed. Only adhesions were found on necropsy, with no differences between groups. CONCLUSION The single-port umbilical and transvaginal NOTES access approaches were feasible and safe compared to laparoscopic and laparotomy for cholecystectomy.
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Affiliation(s)
| | - Josiel Paiva Vieira
- Department of Surgery, Universidade Federal do Maranhão, Sao Luis, MA, Brazil
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Chang SKY, Wang YL, Shen L, Iyer SG, Madhavan K. A randomized controlled trial comparing post-operative pain in single-incision laparoscopic cholecystectomy versus conventional laparoscopic cholecystectomy. World J Surg 2015; 39:897-904. [PMID: 25446490 DOI: 10.1007/s00268-014-2903-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION An increasing body of evidence is being published about single-incision laparoscopic cholecystectomy (SILC), but there are no well-powered trials with an adequate evaluation of post-operative pain. This randomized trial compares SILC against four-port laparoscopic cholecystectomy (LC) with post-operative pain as the primary endpoint. METHODS Hundred patients were randomized to either SILC (n = 50) or LC (n = 50). Exclusion criteria were (1) Acute cholecystitis; (2) ASA 3 or above; (3) Bleeding disorders; and (4) Previous open upper abdominal surgery. Patients and post-operative assessors were blinded to the procedure performed. The site and severity of pain were compared at 4 h, 24 h, 14 days and 6 months post-procedure using the visual analog scale; non-inferiority was assumed when the lower boundary of the 95% confidence interval of the difference was above -1 and superiority when p ≤ 0.05. RESULTS The study arms were demographically similar. At 24 h post-procedure, SILC was associated with less pain at extra-umbilical sites (rest: p = 0.004; movement: p = 0.008). Pain data were inconclusive at 24 h at the umbilical site on movement; SILC was otherwise non-inferior for pain at all other points. Operating duration was longer in SILC (79.46 vs 58.88 min, p = 0.003). 8% of patients in each arm suffered complications (p = 1.000). Re-intervention rates, analgesic use, return to function, and patient satisfaction did not differ significantly. CONCLUSIONS SILC has improved short-term pain outcomes compared to LC and is not inferior in both short-term and long-term pain outcomes. The operating time is longer, but remains feasible in routine surgical practice.
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Affiliation(s)
- Stephen Kin Yong Chang
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, National University Health System, 1E Kent Ridge Road, NUHS Tower Block, Level 8, Singapore, 119228, Singapore,
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Atallah S, Martin-Perez B, Keller D, Burke J, Hunter L. Natural-orifice transluminal endoscopic surgery. Br J Surg 2015; 102:e73-92. [PMID: 25627137 DOI: 10.1002/bjs.9710] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Accepted: 10/20/2014] [Indexed: 02/06/2023]
Abstract
BACKGROUND Natural-orifice transluminal endoscopic surgery (NOTES) represents one of the most significant innovations in surgery to emerge since the advent of laparoscopy. A decade of progress with this approach has now been catalogued, and yet its clinical application remains controversial. METHODS A PubMed search was carried out for articles describing NOTES in both the preclinical and the clinical setting. Public perceptions and expert opinion regarding NOTES in the published literature were analysed carefully. RESULTS Two hundred relevant articles on NOTES were studied and the outcomes reviewed. A division between direct- and indirect-target NOTES was established. The areas with the most promising clinical application included direct-target NOTES, such as transanal total mesorectal excision and peroral endoscopic myotomy. The clinical experience with distant-target NOTES, such as for appendicectomy and cholecystectomy, showed feasibility; however, NOTES-specific morbidity was introduced and this represents an important limitation. CONCLUSION NOTES experimentation in the preclinical setting has increased substantially. There has also been a significant increase in the application of NOTES in humans in the past decade. Enthusiasm for NOTES should be tempered by the risk of incurring NOTES-specific morbidity. Surgeons should carefully consider patient preferences regarding this new minimally invasive option, as opinions are not unanimously supportive of NOTES. As technical limitations are overcome, the clinical application of NOTES is predicted to increase. It is paramount that, when this complex technique is performed on humans, it is applied judiciously by appropriately trained experts with outcomes recorded in a registry.
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Affiliation(s)
- S Atallah
- Department of Colon and Rectal Surgery, Florida Hospital, Orlando, Florida
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Hybrid NOTES: TEO for transanal total mesorectal excision: intracorporeal resection and anastomosis. Surg Endosc 2015; 30:346-54. [PMID: 25814073 DOI: 10.1007/s00464-015-4170-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Accepted: 03/02/2015] [Indexed: 12/14/2022]
Abstract
BACKGROUND Laparoscopic surgery for rectal TME achieves better patient recovery, lower morbidity, and shorter hospital stay than open surgery. However, in laparoscopic rectal surgery, the overall conversion rate is nearly 20%. Transanal TME combined with laparoscopy, known as Hybrid NOTES, is a less invasive procedure that provides adequate solutions to some of the limitations of rectal laparoscopy. Transanal TME via TEO with technical variants (intracorporeal resection and anastomosis, TEO review of the anastomosis) attempts to standardize and simplify the procedure. METHOD Prospective observational study was used describe and assess the technique in terms of conversion to open surgery, overall morbidity, surgical site infection and hospital stay. The sample comprised consecutive patients diagnosed with rectal tumor less than 10 cm from the anal verge who were candidates for low anterior resection using TME (except T4). Demographic, surgical, postoperative, and pathological variables were analyzed, as well as morbidity rates. RESULTS From September 2012 to August 2014, 32 patients were included. The conversion rate was 0%. Overall morbidity was 31.3%, SSI rate was 9.4%, and mean hospital stay was 8 days. Oncological radical criteria were achieved with pathological parameters of 94% of complete TME and a median circumferential margin of 13 mm. CONCLUSION The introduction of technical variants of TEO for transanal resection can facilitate a procedure that requires extensive experience in transanal and laparoscopic surgery. Studies of sphincter function, quality of life, and long-term oncological outcome are now necessary.
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Zygomalas A, Kehagias I, Giokas K, Koutsouris D. Miniature Surgical Robots in the Era of NOTES and LESS. Surg Innov 2015; 22:97-107. [DOI: 10.1177/1553350614532549] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Abstract
Laparoscopy is an established method for the treatment of numerous surgical conditions. Natural orifice transluminal endoscopic surgery (NOTES) is a novel surgical technique that uses the natural orifices of the human body as entrances to the abdominal cavity. An alternative concept of minimally invasive approach to the abdominal cavity is to insert all the laparoscopic instruments through ports using a single small incision on the abdominal wall. A suggested name for this technique is laparoendoscopic single-site surgery (LESS). Considering the technical difficulties in NOTES and LESS and the progress in informatics and robotics, the use of robots seems ideal. The aim of this study is to investigate if there is at present, a realistic possibility of using miniature robots in NOTES or LESS in daily clinical practice. An up-to-date review on in vivo surgical miniature robots is made. A Web-based research of the English literature up to March 2013 using PubMed, Scopus, and Google Scholar as search engines was performed. The development of in vivo miniature robots for use in NOTES or LESS is a reality with great advancements, potential advantages, and possible application in minimally invasive surgery in the future. However, true totally NOTES or LESS procedures on humans using miniature robots either solely or as assistance, remain a dream at present.
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Clinical NOTES appendectomy study: comparison of transvaginal NOTES appendectomy in hybrid technique with laparoscopic appendectomy. Int J Colorectal Dis 2015; 30:259-67. [PMID: 25533898 DOI: 10.1007/s00384-014-2081-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/20/2014] [Indexed: 02/04/2023]
Abstract
PURPOSE The proposed advantages of NOTES are aimed to assess the comparison with standard procedures. Complications are a major focus of its evaluation. We initiated a prospective comparison between transvaginal hybrid appendectomy versus laparoscopic appendectomy. PATIENTS AND METHODS For each, NOTES and laparoscopic appendectomy, 10 consecutive female patients participated in the study with follow-up documentation for 35 days and after 1 year. Transvaginal appendectomy was considered a non-standard medical procedure and required individual patient's consent. Pre- and postoperative gynecological examinations were performed. Questionnaire-based evaluation included issues related to quality of life in addition to objective clinical findings. The study is approved by the ethics committee of the University of Rostock. RESULTS All women returned questionnaires for evaluation. Age and BMI are comparable. Overall procedure time was significantly shorter in laparoscopy. The only postoperative complication consisted of an intra-abdominal abscess after laparoscopic appendectomy. One patient of the NOTES group suffered from new abdominal pain 3 weeks postoperatively; a mini-laparoscopy showed a normal situation. Significant differences (p < 0.05) of the questionnaire-based comparison with advantages for the NOTES group were found in following items: reduced activity at day 1-14, postoperative pain at day 1, general health conditions at day 1-3 and quality of life at day 3. NOTES patients wished significantly earlier to be discharged and started significantly earlier with activities, but no differences existed after 4 weeks. CONCLUSIONS Transvaginal flexible appendectomy appears to be a safe procedure performed in hybrid technique. Data from the study point to shortened recovery intervals and improved quality of life.
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Transvaginal appendectomy: a systematic review. Minim Invasive Surg 2014; 2014:384706. [PMID: 25614832 PMCID: PMC4295586 DOI: 10.1155/2014/384706] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Accepted: 12/04/2014] [Indexed: 01/31/2023] Open
Abstract
Background. Natural orifice transluminal endoscopic surgery (NOTES) is a new approach that allows minimal invasive surgery through the mouth, anus, or vagina. Objective. To summarize the recent clinical appraisal, feasibility, complications, and limitations of transvaginal appendectomy for humans and outline the techniques. Data Sources. PubMed/MEDLINE, Cochrane, Google-Scholar, EBSCO, clinicaltrials.gov and congress abstracts, were searched. Study Selection. All related reports were included, irrespective of age, region, race, obesity, comorbidities or history of previous surgery. No restrictions were made in terms of language, country or journal. Main Outcome Measures. Patient selection criteria, surgical techniques, and results. Results. There were total 112 transvaginal appendectomies. All the selected patients had uncomplicated appendicitis and there were no morbidly obese patients. There was no standard surgical technique for transvaginal appendectomy. Mean operating time was 53.3 minutes (25–130 minutes). Conversion and complication rates were 3.6% and 8.2%, respectively. Mean length of hospital stay was 1.9 days. Limitations. There are a limited number of comparative studies and an absence of randomized studies. Conclusions. For now, nonmorbidly obese females with noncomplicated appendicitis can be a candidate for transvaginal appendectomy. It may decrease postoperative pain and enable the return to normal life and work off time. More comparative studies including subgroups are necessary.
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Wang ZK, Yang YS, Zhang XL, Sun G, Hyder Q, Wu LL, Tang P, Li W. Comparison in efficacy between pure NOTES peritoneoscopy with small or large endoscope and laparoscopy. J Dig Dis 2014; 15:628-35. [PMID: 25244524 DOI: 10.1111/1751-2980.12187] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To evaluate the efficacy and systematic impact of different sized endoscopes for pure transgastric natural orifice transluminal endoscopic surgery (NOTES) peritoneoscopy relative to laparoscopy. METHODS A total of 15 dogs were randomly assigned to the small-sized endoscope (SS), large-sized endoscope (LS) and standard laparoscopy (SL) groups. The procedure time, visualization scores for abdominal organs, gastric incision healing times and procedure-associated complications were recorded. Blood samples were collected at 1 h preoperation and at 1 h, 12 h, 2 days and 7 days postoperation. Serum tumor necrosis factor (TNF)-α and interleukin (IL)-6 levels as well as peripheral white blood cell (WBC) counts were analyzed. RESULTS Peritoneoscopy was successfully performed with both pure transgastric NOTES and laparoscopy. The peritoneoscopy required less time to complete in the SL group (44.0 ± 7.0 min) than the LS (83.0 ± 28.9 min) and SS (106.6 ± 81.3 min) groups (P < 0.01), but no statistical difference was observed between the SS and LS groups (P > 0.05). The visualization scores of peritoneal organs among the three groups did not differ significantly (P > 0.05). The gastric incision exhibited satisfactory healing in both the SS and LS groups. Moreover, serum TNF-α and IL-6 levels and WBC counts at each time point were similar among the three groups (P > 0.05). CONCLUSIONS Small-sized endoscope is not superior to a large-sized one for pure transgastric NOTES peritoneoscopy. Pure transgastric NOTES is not less invasive or less time-consuming than laparoscopy.
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Affiliation(s)
- Zi Kai Wang
- Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Beijing, China
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25
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Abstract
PURPOSE OF REVIEW Laparoendoscopic single-site surgery (LESS) and natural orifice transluminal endoscopic surgery (NOTES) are novel techniques with potential to minimize the morbidity of surgery. Challenging ergonomics, instrument clashing, and the lack of true triangluation still remain great concerns. RECENT FINDINGS New technological developments in instrument design have been created to enhance clinical applicability of these techniques. Further technological advancements including the incorporation of novel robotic surgical platforms (R-LESS) exploit the ergonomic benefits in an attempt to further advance LESS surgery. Promising devices include magnetic anchoring and guidance systems that have the potential to allow external manoeuvring of intracorporeal instruments while facilitating triangulation and reducing clashing. As well, the benefit of miniature in-vivo robots that can be placed endoscopically intra-abdominally and controlled wirelessly will allow internal manipulation of tissue from internal repositionable platforms. SUMMARY It remains to be seen whether LESS or NOTES will prove their clinical benefit over standard laparoscopic or robotic procedures. In this chapter, we review the current LESS and NOTES technology, and focus on new innovations and research in the field.
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Laparoscopy-assisted transvaginal resection of sigmoid cancer. Eur J Surg Oncol 2014; 40:713-8. [DOI: 10.1016/j.ejso.2014.01.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Revised: 12/13/2013] [Accepted: 01/13/2014] [Indexed: 01/26/2023] Open
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Abstract
The gold standard for the surgical treatment of symptomatic cholelithiasis is conventional laparoscopic cholecystectomy (LC). Although it has been associated with a slightly higher incidence of bile duct injury (BDI) in comparison with open cholecystectomy (OC), LC is considered a very safe operation. Prevention of BDI should be routinely performed in every LC. Recent trends include the performance of cholecystectomy through a single incision and NOTES (Natural Orifice Transluminal Endoscopic Surgery). However, lack of evidence of clinical advantages prevents their widespread adoption, and more data are needed to assess whether their use is warranted.
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Abstract
Laparoscopy is an established method for the treatment of numerous surgical conditions. Natural orifice transluminal endoscopic surgery (NOTES) is a novel surgical technique that uses the natural orifices of the human body as entrances to the abdominal cavity. An alternative concept of minimally invasive approach to the abdominal cavity is to insert all the laparoscopic instruments through ports using a single small incision on the abdominal wall. A suggested name for this technique is laparoendoscopic single-site surgery (LESS). Considering the technical difficulties in NOTES and LESS and the progress in informatics and robotics, the use of robots seems ideal. The aim of this study is to investigate if there is at present, a realistic possibility of using miniature robots in NOTES or LESS in daily clinical practice. An up-to-date review on in vivo surgical miniature robots is made. A Web-based research of the English literature up to March 2013 using PubMed, Scopus, and Google Scholar as search engines was performed. The development of in vivo miniature robots for use in NOTES or LESS is a reality with great advancements, potential advantages, and possible application in minimally invasive surgery in the future. However, true totally NOTES or LESS procedures on humans using miniature robots either solely or as assistance, remain a dream at present.
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29
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McLemore EC, Weston LA, Coker AM, Jacobsen GR, Talamini MA, Horgan S, Ramamoorthy SL. Transanal minimally invasive surgery for benign and malignant rectal neoplasia. Am J Surg 2014; 208:372-81. [PMID: 24832238 DOI: 10.1016/j.amjsurg.2014.01.006] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Revised: 12/27/2013] [Accepted: 01/05/2014] [Indexed: 12/16/2022]
Abstract
BACKGROUND Transanal minimally invasive surgery (TAMIS), an alternative technique to transanal endoscopic microsurgery, was developed in 2009. Herein, we describe our initial experience using TAMIS for benign and malignant rectal neoplasia. METHODS This is an institutional review board approved, retrospective case series report. RESULTS TAMIS was performed in 32 patients for rectal adenoma (13), adenocarcinoma (16), and carcinoid (3). There were 14 women, with mean age 62 ± 15 years and body mass index 28 ± 5 kg/m(2). Lesion size ranged from .5 to 8.5 cm, distance from the dentate line 1 to 11 cm, and circumference of the lesion 10% to 100%. The mean operative time was 123 ± 62 minutes. Mean hospital length of stay was 2.5 ± 2 days. Complications included urinary tract infection (1), Clostridium difficile diarrhea (1), atrial fibrillation (1), rectal stenosis (1), and rectal bleeding (1). CONCLUSION TAMIS using a disposable transanal access platform is a safe and effective method to remove rectal lesions in this case series.
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Affiliation(s)
| | - Lynn A Weston
- Department of Surgery, Scripps Health Systems, San Diego, CA, USA
| | - Alisa M Coker
- Department of Surgery, University of California, San Diego, CA, USA
| | - Garth R Jacobsen
- Department of Surgery, University of California, San Diego, CA, USA
| | - Mark A Talamini
- Department of Surgery, University of California, San Diego, CA, USA
| | - Santiago Horgan
- Department of Surgery, University of California, San Diego, CA, USA
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Escisión total del mesorrecto por vía transanal. Cir Esp 2014; 92:221-2. [DOI: 10.1016/j.ciresp.2014.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2013] [Revised: 12/26/2013] [Accepted: 01/09/2014] [Indexed: 11/24/2022]
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Komorowski AL, Alba Mesa F, Bała MM, Mituś JW, Wysocki WM. Systematic Review and Meta-analysis of Complications in Transvaginal Approach in Laparoscopic Surgery. Indian J Surg 2014; 77:853-62. [PMID: 27011470 DOI: 10.1007/s12262-014-1038-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2013] [Accepted: 01/20/2014] [Indexed: 10/25/2022] Open
Abstract
Transvaginal access is the most popular natural orifice translumenal technique in the minimally invasive surgery. Reviews on non-gynecological transvaginal approach morbidities reveal that rates vary greatly. A systematic review of transvaginal approach in non-gynecological intraabdominal procedures was carried out to assess the risk of complications. A systematic search was conducted using MEDLINE, EMBASE, PubMed, and the Cochrane Library from the inception of these databases to March 2012. The following keywords were searched: "transvaginal", "NOTES", "single incision", and "single port". From the total of 231 potentially eligible abstracts, 87 papers were retrieved and evaluated as fulfilling the eligibility criteria. The final analysis included 32 articles. The overall complications rate was 4.4 %, and complications related to the transvaginal port reached 2.4 %. Conversion rate to open surgery was 3.4 %. The incidence of postoperative urinary tract infection was 0.8 %. The mean operative time was 119 min. The mean hospital stay was 3.1 days (range 6 h-12 days). The technique of transvaginal access can offer several advantages for a patient and is associated with an acceptable rate of complications.
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Affiliation(s)
- Andrzej L Komorowski
- Department of Surgical Oncology, Cancer Centre, Maria Skłodowska-Curie Memorial Institute, Kraków ul. Garncarska 11, 31-115 Kraków, Poland
| | - Francisco Alba Mesa
- Consorcio Sanitario Publico del Aljarafe, Hospital San Juan de Dios, Bormujos, Sevilla Spain
| | - Małgorzata M Bała
- 2nd Department of Internal Medicine, Jagiellonian University Medical College, Kraków, Poland
| | - Jerzy W Mituś
- Department of Surgical Oncology, Cancer Centre, Maria Skłodowska-Curie Memorial Institute, Kraków ul. Garncarska 11, 31-115 Kraków, Poland ; Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | - Wojciech M Wysocki
- Department of Surgical Oncology, Cancer Centre, Maria Skłodowska-Curie Memorial Institute, Kraków ul. Garncarska 11, 31-115 Kraków, Poland
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Bingener J, Ibrahim-zada I. Natural orifice transluminal endoscopic surgery for intra-abdominal emergency conditions. Br J Surg 2013; 101:e80-9. [PMID: 24273005 DOI: 10.1002/bjs.9352] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2013] [Indexed: 12/12/2022]
Abstract
BACKGROUND Patient benefits from natural orifice transluminal endoscopic surgery (NOTES) are of interest in acute-care surgery. This review provides an overview of the historical development of NOTES procedures, and addresses their current uses and limitations for intra-abdominal emergency conditions. METHODS A PubMed search was carried out for articles describing NOTES approaches for appendicectomy, percutaneous gastrostomy, hollow viscus perforation and pancreatic necrosectomy. Pertinent articles were reviewed and data on available outcomes synthesized. RESULTS Emergency conditions in surgery tax the patient's cardiovascular and respiratory systems, and fluid and electrolyte balance. The operative intervention itself leads to an inflammatory response and blood loss, thus adding to the physiological stress. NOTES provides a minimally invasive alternative access to the peritoneal cavity, avoiding abdominal wall incisions. A clear advantage to the patient is evident with the implementation of an endoscopic approach to deal with inadvertently displaced percutaneous endoscopic gastrostomy tubes and perforated gastroduodenal ulcer. The NOTES approach appears less invasive for patients with infected pancreatic necrosis, in whom it allows surgical debridement and avoidance of open necrosectomy. Transvaginal appendicectomy is the second most frequently performed NOTES procedure after cholecystectomy. The NOTES concept has provided a change in perspective for intramural and transmural endoscopic approaches to iatrogenic perforations during endoscopy. CONCLUSION NOTES approaches have been implemented in clinical practice over the past decade. Selected techniques offer reduced invasiveness for patients with intra-abdominal emergencies, and may improve outcomes. Steady future development and adoption of NOTES are likely to follow as technology improves and surgeons become comfortable with the approaches.
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Affiliation(s)
- J Bingener
- Department of Surgery, Mayo Clinic, Rochester, Minnesota, USA
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Liu L, Chiu PWY, Reddy N, Ho KY, Kitano S, Seo DW, Tajiri H. Natural orifice transluminal endoscopic surgery (NOTES) for clinical management of intra-abdominal diseases. Dig Endosc 2013; 25:565-77. [PMID: 23967798 DOI: 10.1111/den.12154] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Accepted: 07/04/2013] [Indexed: 12/20/2022]
Abstract
Clinical research on natural orifice transluminal endoscopic surgery (NOTES) has been increasingly reported over the past 5 years and more than 1200 patients have received various NOTES procedures. The present article reviews the clinical practice of NOTES for the treatment of intra-abdominal diseases, and was carried out through systematic search with specific keywords in major databases for NOTES-related clinical literature. The last date of the search was 15 August, 2012. Transvaginal cholecystectomy is the commonest NOTES procedure reported, and its clinical feasibility and safety was established through prospective case series and randomized trials. There is a regional difference in NOTES development with the majority of NOTES fromCaucasian countries being transvaginal cholecystectomy and most reports from Asian countries being NOTES-related procedures. Safe closure of gastrointestinal access remains challenging, and novel endoscopic instruments are essential to enhance future development of NOTES.
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Affiliation(s)
- Liu Liu
- Department of Surgery, Chinese University of Hong Kong, Hong Kong, China
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Jacobsen GR, Barajas-Gamboa JS, Coker AM, Cheverie J, Macias CA, Sandler BJ, Talamini MA, Horgan S. Transvaginal organ extraction: potential for broad clinical application. Surg Endosc 2013; 28:484-91. [PMID: 24149847 DOI: 10.1007/s00464-013-3227-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2013] [Accepted: 09/17/2013] [Indexed: 12/12/2022]
Abstract
BACKGROUND Natural orifice transluminal endoscopic surgery procedures have evolved over the past few years. A transvaginal approach is a promising alternative for intraperitoneal procedures. Our objective was to evaluate the safety and feasibility of transvaginal organ extraction. METHODS This institutional review board-approved protocol involved retrospective review of an ongoing prospective study. Female subjects who presented to our hospital for elective cholecystectomy, appendectomy, or sleeve gastrectomy were offered participation in the study. Eligible patients met the following criteria: age between 18 and 75, diagnosis of gallbladder disease, acute appendicitis, or morbid obesity who desired surgical treatment. A hybrid transvaginal natural orifice approach was used in this series. RESULTS Thirty-four women underwent transvaginal organ extraction between September 2007 and January 2012. The mean age was 40 ± 12.1 years (range 23-63 years). The mean body mass index was 27 ± 6.4 kg/m(2) (range 16-43 kg/m(2)). All patients had an American Society of Anesthesiologists classification of two or below. The mean operative time for cholecystectomy, appendectomy, and sleeve gastrectomy was 90, 71, and 135 min, respectively. There were no conversions to open operation and no intraoperative complications. The mean hospital stay was 2 days for all cases. Patients were followed for a mean of 24 months (range 1-61 months). There were two pregnancies and two successful vaginal deliveries. Six patients (18 %) had minor complaints of spotting or heavy menses in the immediate postoperative period that resolved with conservative measures. There were no abdominal wall complications. There were no long-term complications and no mortalities. CONCLUSIONS This initial experience suggests that this surgical approach is safe, does not increase length of stay, and has no long-term vaginal complications. Given this attractive profile, a transvaginal approach may prove to be a superior mode of organ extraction, although randomized studies and long-term follow-up are needed.
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Affiliation(s)
- Garth R Jacobsen
- Department of Surgery, University of California at San Diego, San Diego, CA, USA
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Min Seow C, Jian Chin W, Nelson CA, Nakamura A, Farritor SM, Oleynikov D. Articulated Manipulator With Multiple Instruments for Natural Orifice Transluminal Endoscopic Surgery. J Med Device 2013. [DOI: 10.1115/1.4025183] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
This paper presents an articulated manipulator with multiple instruments for natural orifice endoscopic transluminal endoscopic surgery (NOTES). This robotic system is made up of four major components, namely a multifunctional manipulator, a robot-connecting arm, an articulated drive mechanism, and a surgeon control console. The manipulator, capable of changing instruments in situ at the surgical site, was developed to reduce infection risk, improve surgical workflow, and encourage solo surgery by providing surgeons with all the required instruments. The robot-connecting arm serves as an experimental platform for future bimanual robot configurations. To facilitate stable positioning and optimal orientation of the robot, the articulated drive mechanism was also created. The surgeon control console provides a user-friendly platform to receive system input from surgeons. Benchtop testing showed adequate articulation and tool-tip forces for accomplishment of typical tasks in abdominal surgery. This system leverages the benefits both of cable-wire actuation systems and of direct motor embedding on different components to achieve better tool triangulation, higher instrument grasping force, and improved positioning at the surgical site.
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Affiliation(s)
| | | | | | | | - Shane M. Farritor
- Department of Mechanical and Materials Engineering, University of Nebraska-Lincoln, W342 NH Lincoln, NE 68588-0526
| | - Dmitry Oleynikov
- Department of Surgery, Center for Advanced Surgical Technology, University of Nebraska Medical Center, 985126 Nebraska Medical Center, Omaha, NE 68198-3280
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Pure NOTES transvaginal appendectomy with gasless laparoscopy. J Surg Res 2013; 186:179-83. [PMID: 24095022 DOI: 10.1016/j.jss.2013.08.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2013] [Revised: 07/28/2013] [Accepted: 08/27/2013] [Indexed: 11/22/2022]
Abstract
BACKGROUND The vagina is the most widely used approach to natural orifice transluminal endoscopic surgery. However, a gas leak can significantly affect transvaginal operations during pneumoperitoneum laparoscopy. We tried to establish the proper technique for transvaginal appendectomy under gasless laparoscopy. MATERIALS AND METHODS Five patients with chronic appendicitis were selected to receive gasless laparoscopic transvaginal appendectomy with concurrent vaginal hysterectomy. An abdominal wall-lifting device was applied after removal of the uterus, and the appendix was removed transvaginally. Clinical data such as operative duration, bleeding volume, morbidity, and hospital stay duration were analyzed. RESULTS All procedures were performed successfully, without intraoperative or major postoperative complications. The appendectomy portion of the procedure took approximately 20-30 minutes, with minimal blood loss. All patients were discharged, scar-free, 3 d after surgery. CONCLUSIONS Transvaginal appendectomy with gasless laparoscopy after vaginal hysterectomy appears to be a feasible and safe modification of established techniques, with acceptable outcomes.
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Zygomalas A, Giokas K, Koutsouris D. Modular Assembly Micro-Robots for Natural Orifice Transluminal Endoscopic Surgery. ROBOTICS 2013. [DOI: 10.4018/978-1-4666-4607-0.ch078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Surgical operations are progressively being performed using minimally invasive techniques. Natural Orifice Transluminal Endoscopic Surgery (NOTES) is a novel surgical technique that uses the natural orifices of the human body in order to approach the peritoneal cavity. There are two basic types of robotics for NOTES; the external robots that stay outside the patient but act inside the abdominal cavity, and the internal robots that stay and act in the abdomen. The internal robots could only be mini-robots. The development of modular assembling reconfigurable micro-robots is a revolutionary idea for the NOTES. Modular micro-robots consist of small subunits which could be assembled and construct a functional miniature robot. These surgical micro-robots may increase the possibility for true scarless tele-surgery. Although specific applications of intrabdominal surgical micro-robots are still in an early concept stage, the field is rapidly evolving. In the future, patients may be operated by specialized micro-robotic intrabdominal surgeons.
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Affiliation(s)
- Apollon Zygomalas
- University of Patras, Greece & University Hospital of Patras, Greece
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Demura Y, Ishikawa N, Hirano Y, Inaki N, Matsunoki A, Watanabe G. Transrectal robotic natural orifice translumenal endoscopic surgery (NOTES) applied to intestinal anastomosis in a porcine intestine model. Surg Endosc 2013; 27:4693-701. [DOI: 10.1007/s00464-013-3117-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Accepted: 07/17/2013] [Indexed: 12/13/2022]
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Tomasko JM, Mathew A, Moyer MT, Haluck RS, Pauli EM. An intestinal occlusion device for prevention of small bowel distention during transgastric natural orifice transluminal endoscopic surgery. JSLS 2013; 17:306-11. [PMID: 23925026 PMCID: PMC3771799 DOI: 10.4293/108680813x13693422521197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
An intestinal occlusion catheter that maintains duodenal occlusion significantly improves intra-abdominal visualization during a NOTES procedure. Background and Objectives: Bowel distention from luminal gas insufflation reduces the peritoneal operative domain during natural orifice transluminal endoscopic surgery (NOTES) procedures, increases the risk for iatrogenic injury, and leads to postoperative patient discomfort. Methods: A prototype duodenal occlusion device was placed in the duodenum before NOTES in 28 female pigs. The occlusion balloon was inflated and left in place during the procedure, and small bowel distension was subjectively graded. One animal had no balloon occlusion, and 4 animals had a noncompliant balloon placed. Results: The balloon maintained its position and duodenal occlusion in 22 animals (79%) in which the bowel distention was rated as none (15), minor (4), moderate (3), or severe (0). The intestinal occlusion catheter failed in 6 animals (21%) because of balloon leak (5) or back-migration into the stomach (1), with distention rated as severe in 5 of these 6 cases. Conclusion: The intestinal occlusion catheter that maintains duodenal occlusion significantly improves the intra-abdominal working domain with enhanced visualization of the viscera during the NOTES procedure while requiring minimal time and expense.
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Affiliation(s)
- Jonathan M Tomasko
- Division of Minimally Invasive Surgery, Penn State Hershey Medical Center, Hershey, PA, USA
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Moustarah F, Talarico J, Zinc J, Gatmaitan P, Brethauer S. NOTES for the management of an intra-abdominal abscess: transcolonic peritonoscopy and abscess drainage in a canine model. Can J Surg 2013; 56:159-66. [PMID: 23706846 DOI: 10.1503/cjs.037111] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND We studied natural orifice transcolonic drainage of intra-abdominal abscesses in a canine survival model to evaluate the difficulty of peritonoscopy and abscess drainage and the reliability of endoluminal colotomy closure. METHODS We placed a 7 cm nonsterile saline-filled latex balloon intra-abdominally to mimic or induce an abscess or inflammatory mass. Seven days later, we advanced a single-channel endoscope transanally into the sigmoid colon of the animal, made a colotomy and then advanced the endoscope intraperitoneally. We evacuated the identified abscess and placed a drain transabdominally. We closed the colotomy endoluminally with a tissue approximation system using 2 polypropylene sutures attached to metal T-bars. Two weeks later, we evaluated the colotomy closure at laparotomy. RESULTS We studied 12 dogs: 8 had subphrenic balloon implants and 4 had interbowel loop implants. Eleven survived and underwent transcolonic peritonoscopy; we identified the "abscess" in 9. The colotomy was successfully closed in 10 of 11 dogs. Although abscesses were easily identified, the overall difficulty of the peritonoscopy was moderate to severe. One dog required colotomy closure via laparotomy, while 9 had successful endoluminal closure. After colotomy closure, 8 animals survived for 2 weeks (study end point) without surgical complications, sepsis or localized abdominal infections. On postmortem examination, all closures were intact without any adjacent organ damage or procedure-related complications. CONCLUSION Natural orifice transluminal endoscopic surgery provides a novel alternative to treating intra-abdominal pathology. It is technically feasible to perform endoscopic transcolonic peritonoscopy and drainage of an intra-abdominal abscess with reliable closure of the colotomy in a canine experimental model.
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Affiliation(s)
- Fady Moustarah
- From the Bariatric and Metabolic Institute, Cleveland Clinic Foundation, Ohio, and the Département de chirurgie, Université Laval, Québec, Canada.
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Chinese physician perception of natural orifice translumenal endoscopic surgery. Dig Dis Sci 2013; 58:2167-76. [PMID: 23516034 DOI: 10.1007/s10620-013-2637-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Accepted: 03/07/2013] [Indexed: 02/06/2023]
Abstract
BACKGROUND A gross difference of opinion prevails amongst the physicians about the acceptance of natural orifice translumenal endoscopic surgery (NOTES). AIMS The purpose of this study was to explore the Chinese physician perception of NOTES. METHODS This is a questionnaire-based study, which was conducted during a conference on gastroenterology and endoscopy. The information was obtained from the participants about the demographic and practice characteristics and their perception of NOTES. RESULTS The study recruited 221 physicians: 192 gastroenterologists and 29 surgeons. The physicians' awareness of NOTES prior to the survey showed the same confidence with NOTES as compared to those with no knowledge about it (24.2 vs. 25.6 %; P = 0.99). The NOTES preference was not different between female and male doctors (21.8 vs. 26.3 %; P = 0.5952). More surgeons (47.6 %) opted for NOTES as treatment or recommended it for their families than gastroenterologists (21.1 %; P = 0.0165). However, the multivariate analysis confirmed that the physicians chose NOTES only if their hospital had already performed NOTES on humans successfully (OR = 3.53, 95 % CI 1.17-10.60; P = 0.0247). The gastroenterologists believed more often than surgeons that NOTES had the potential to become a mainstream procedure (96.9 vs. 81.0 %; P = 0.0084); but the inclination for NOTES training was similar in both groups (96.9 vs. 95.2 %; P = 0.8027). Safety of NOTES was their major concern and the choice of ideal entry point was thought to be the key barrier to NOTES clinical application. Hybrid NOTES was regarded as the best method for NOTES clinical application at the time of the study. CONCLUSIONS Physicians were hesitant when considering the NOTES approach. However, most of the physicians were interested in NOTES training and had confidence in NOTES.
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Zhu LH, Chen L, Yang S, Liu D, Zhang J, Cheng X, Chen W. Embryonic NOTES thoracic sympathectomy for palmar hyperhidrosis: results of a novel technique and comparison with the conventional VATS procedure. Surg Endosc 2013; 27:4124-9. [DOI: 10.1007/s00464-013-3079-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Accepted: 06/17/2013] [Indexed: 10/26/2022]
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Meireles OR, Horgan S, Jacobsen GR, Katagiri T, Mathew A, Sedrak M, Sandler BJ, Dotai T, Savides TJ, Majid SF, Nijhawan S, Talamini MA. Transesophageal endoscopic myotomy (TEEM) for the treatment of achalasia: the United States human experience. Surg Endosc 2013; 27:1803-9. [PMID: 23525881 DOI: 10.1007/s00464-012-2666-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2012] [Accepted: 10/18/2012] [Indexed: 12/24/2022]
Abstract
BACKGROUND From our early experience with NOTES, our group has acquired familiarity with transesophageal submucosal dissection and myotomy in swine model, which allowed us to perfect a model to perform purely endoscopic transesophageal myotomy (TEEM) for the treatment of achalasia and apply it into clinical practice. This study was designed to assess the safety, feasibility, and efficacy of TEEM in a series of patients with achalasia. METHODS Under institutional review board approval, patients were enrolled on our study, where TEEM was offered as an alternative to laparoscopic or robotic Heller myotomy. The inclusion criteria were patients with achalasia confirmed by esophageal manometry, between age 18 and 50 years, and ASA class 2 or lower. The exclusion criteria were pregnancy, prior esophageal surgery, immunosuppression, coagulopathies, and severe medical comorbidities. The procedures were performed under general anesthesia, with the patient in supine position on positive pressure ventilation. With a GIF-180 (Olympus, Tokyo, Japan) positioned at 10 cm above the GEJ, a mucosotomy was performed at the 2 o'clock position, and a submucosal space was developed caudally creating a controlled submucosal tunnel extending 2 cm distal to the GEJ. Upon completion of this tunnel the gastroesophageal lumen was inspected for mucosal integrity. The scope was then reinserted into the submucosal tunnel and using a triangle-tip knife, myotomy was performed starting at 5 cm above the GEJ and ending at 2 cm below the GEJ. During this process the circular muscle layer of the esophagus was carefully divided with preservation of the longitudinal layer. At the end of the procedure, the mucosal incision was closed longitudinally with endoscopic clips and surgical glue. RESULTS Five patients underwent TEEM, with no perioperative complication. All patients reported significant improvement of their dysphagia immediately after the procedure. On the first postoperative day, all barium swallows showed disappearance of the classical bird beak taper, rapid emptying of contrast into the stomach, and absence of leaks. All patients were discharged on the second postoperative day on liquid diet. Two patients reported transient heartburn, which were well controlled with medications. The average preoperative GERD-HRQL was 20, which improved to 11.3 at 7 days postoperative and 2 at 30 days postoperative. To date, three patients have already returned for their 6-month follow-up, reporting adequate swallowing and low LES pressures on esophageal manometry (their mean preoperative LES resting pressure was 36.46 mmHg and residual pressure was 43.16 mmHg, whereas the 6-month follow-up mean LES resting pressure was 10.06 mmHg and residual pressure was 0.43 mmHg). CONCLUSIONS TEEM seems to be safe, feasible, and effective for the treatment of patients with achalasia. Long-term data are still necessary for wide-spread utilization of this novel technique.
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Affiliation(s)
- Ozanan R Meireles
- Department of Surgery, University of California San Diego, San Diego, CA, USA.
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de Lacy AM, Rattner DW, Adelsdorfer C, Tasende MM, Fernández M, Delgado S, Sylla P, Martínez-Palli G. Transanal natural orifice transluminal endoscopic surgery (NOTES) rectal resection: “down-to-up” total mesorectal excision (TME)—short-term outcomes in the first 20 cases. Surg Endosc 2013; 27:3165-72. [DOI: 10.1007/s00464-013-2872-0] [Citation(s) in RCA: 227] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2012] [Accepted: 02/05/2013] [Indexed: 12/12/2022]
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Horgan S, Meireles OR, Jacobsen GR, Sandler BJ, Ferreres A, Ramamoorthy S, Savides T, Katagiri T, Dotai T, Sedrak M, Majid SF, Nijhawan S, Talamini MA. Broad clinical utilization of NOTES: is it safe? Surg Endosc 2013; 27:1872-80. [PMID: 23479251 DOI: 10.1007/s00464-012-2736-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2012] [Accepted: 11/08/2012] [Indexed: 12/19/2022]
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Perioperative inflammatory response in natural orifice translumenal endoscopic surgery. Surg Endosc 2013; 27:2551-6. [DOI: 10.1007/s00464-012-2781-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2012] [Accepted: 12/19/2012] [Indexed: 10/27/2022]
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Chang SKY, Wang YL, Shen L, Iyer SG, Shaik ABSB, Lomanto D. Interim report: a randomized controlled trial comparing postoperative pain in single-incision laparoscopic cholecystectomy and conventional laparoscopic cholecystectomy. Asian J Endosc Surg 2013; 6:14-20. [PMID: 22979900 DOI: 10.1111/j.1758-5910.2012.00154.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2011] [Revised: 03/16/2012] [Accepted: 07/30/2012] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Single-incision laparoscopic cholecystectomy (SILC) is increasingly practiced, but there have been no well-powered randomized trials investigating the technique. This non-inferiority trial aims to compare SILC with conventional four-port laparoscopic cholecystectomy (LC) with postoperative pain as the primary endpoint. METHODS We aim to randomize 100 patients into equal arms of SILC or LC. Exclusion criteria were: (i) acute cholecystitis; (ii) an ASA score of 3 or above; (iii) bleeding disorders; or (iv) previous upper abdominal surgery. Patients and postoperative assessors were blinded to the procedure received. The site and severity of pain was compared based on the visual analogue scale at 4 hours, 24 hours and 14 days postoperatively; non-inferiority was assumed when the lower boundary of the 95% confidence interval of the difference was above -1, and superiority when P ≤ 0.05. RESULTS We recruited 24 SILC and 26 LC patients. There were no conversions to open cholecystectomy or from SILC to LC. SILC was non-inferior for pain at umbilical sites at rest and at extra-umbilical sites at all times. At 24 hours postoperatively, SILC was associated with significantly less pain at extra-umbilical sites (rest: P = 0.002; movement: P = 0.004). There were no incidents of biliary injury or retained gallstones. Of the 24 SILC patients, 12.5% had postoperative complications (vomiting, mild fluid overload, wound infection) compared with 0% of LC patients (P = 0.110); all complications resolved with conservative management. Operating time, analgesic use, return to function, and overall satisfaction did not differ significantly between the two groups. CONCLUSION SILC is associated with reduced pain and is feasible in routine surgical practice.
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Nakajima K, Souma Y, Takahashi T, Yamasaki M, Miyazaki Y, Mori M, Doki Y. Anatomical measurements to optimize instrumentation for transvaginal surgery. Surg Endosc 2013; 27:2052-7. [PMID: 23292562 DOI: 10.1007/s00464-012-2709-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2012] [Accepted: 11/06/2012] [Indexed: 12/21/2022]
Abstract
BACKGROUND Use of rigid instruments via transvaginal (TV) route has been proposed as a practical alternative to natural orifice translumenal endoscopic surgery (NOTES) using flexible devices. However, its safety has not been fully evaluated for each abdominal organ with different positional relationship to the vagina. The aim of this study is to obtain baseline anatomical data necessary for safer use of rigid TV instruments, by three-dimensional (3-D) radiologic measurements. PATIENTS AND METHODS A retrospective study was conducted on 51 consecutive female Japanese patients with aortic aneurysm who underwent whole-body multidetector computed tomography as preoperative evaluation. The gallbladder (GB), esophagogastric junction (EGJ), and spleen were located on 3-D images, and the following were obtained: (1) the distance from the vagina, (2) the transverse deviation from the midline, and (3) the sagittal deviation from the "vagina-promontory (V-P)" line. RESULTS The median distance from the vagina was 26.1 cm for GB, 30.6 cm for EGJ, and 31.1 cm for spleen. The transverse deviation from the midline was 17.7° for GB, 7.0° for EGJ, and 12.9° for spleen. The sagittal deviation from the V-P line was 7.6 degrees for GB, -7.0° for EGJ, and -10.3° for spleen. The percentage of "negative angle" cases, which means that the target is located "below" the V-P line, was only 9.8 % for GB versus 88 % for EGJ and spleen. CONCLUSIONS The intra-abdominal length of TV instruments should be more than 35 cm in Japanese population. GB is widely deviated from the midline and therefore can be safely approached even with rigid/straight instruments. Access to more midline and distant targets may suffer from interference by the sacral promontory, and be potentially dangerous in terms of risk of compression injury by rigid and straight instruments.
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Affiliation(s)
- Kiyokazu Nakajima
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan.
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Nau P, Sylla P. Surgical innovation: From laparoscopy to natural orifice translumenal endoscopic surgery. GASTROINTESTINAL INTERVENTION 2012. [DOI: 10.1016/j.gii.2012.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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McLemore EC, Coker A, Jacobsen G, Talamini MA, Horgan S. eTAMIS: endoscopic visualization for transanal minimally invasive surgery. Surg Endosc 2012. [PMID: 23179071 DOI: 10.1007/s00464-012-2652-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Transanal endoscopic microsurgical (TEM) resection is associated with improved outcomes compared to transanal excision of rectal lesions. However, TEM equipment requires additional operative setup time, and tumor location dictates patient positioning. In 2010, Drs. Attallah, Albert, and Larach developed an alternative technique, transanal minimally invasive surgery (TAMIS). Herein, we describe our novel experience using endoscopic visualization to perform TAMIS (eTAMIS) to remove a large rectal polyp. METHODS This is a technical note describing a new surgical technique, eTAMIS. The technique is performed with the Gelpoint Path TAMIS platform (Applied Medical, Rancho Santa Margarita, CA) and a standard single-channel endoscope for visualization. Patient demographics, operative data, and pathologic data were recorded. RESULTS eTAMIS was initially performed in a 50-year-old woman with an endoscopically defiant rectal mass discovered on routine screening colonoscopy. The lesion was a tubulovillous adenoma, 10 cm from the anal verge, anterior, and occupied 15-20 % of the circumference. The rectal mass was removed by eTAMIS. The operative time was 101 minutes, and the patient was discharged within 24 h without event. Final pathology revealed a focus of well-differentiated rectal adenocarcinoma with focal invasion into the muscularis mucosa (Haggit level 0, pTis) arising in the head of a pedunculated tubulovillous adenoma. At 1-year follow-up endoscopy, the patient had no evidence of recurrent mass or polyp. CONCLUSIONS This is the first technical report describing endoscopic visualization for TAMIS. Endoscopic visualization facilitates intraluminal articulation and lens cleaning while minimizing extraluminal instrument collisions. eTAMIS is a practical and logical evolution of the visual approach to natural orifice transluminal endoscopic surgery and laparoendoscopic surgery.
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Affiliation(s)
- Elisabeth C McLemore
- UC San Diego Medical Center, Moores Cancer Center, Department of Surgery, University of California, 3855 Health Sciences Dr., #0987, La Jolla, San Diego, CA 92093-0987, USA.
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