1
|
Lim CH, Lee ZJ, Lye T, Ravishankar A, Yeung B, Ong HS, Tan J. Natural Orifice Transluminal Endoscopic One-Anastomosis Gastric Bypass: a Feasibility Study Using Human Cadavers. Obes Surg 2022; 32:3787-3795. [PMID: 36136170 DOI: 10.1007/s11695-022-06273-9] [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: 07/18/2022] [Revised: 09/04/2022] [Accepted: 09/05/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Endoscopic bariatric therapies (EBT) has emerged as an effective treatment in the management of the patient with obesity. Unfortunately, most procedures involve only the restriction of gastric volume without altering the underlying metabolism. The objective of this study was to investigate the practicability and limitations of the metabolic altering procedures: "One anastomosis gastric bypass (OAGB)" with "natural orifice transluminal endoscopic surgery (NOTES)" on human cadavers. METHODS We performed OAGB with NOTES approach in 3 human cadavers. The steps of the procedure can be divided as follows: step 1, endoscopic sleeve gastroplasty (ESG); step 2, trans-gastric access to peritoneal cavity; step 3, identification of suitable loop of jejunum; step 4, introduction of the jejunal loop into the stomach; step 5, creation of the gastro-jejunostomy with lumen-apposing metal stent (LAMS); step 6, gastric pylorus occlusion with overstitch. RESULTS We performed OAGB with NOTES in 3 human cadavers with bypassed bilio-pancreatic limb of 55, 75, and 105 cm from the pylorus. The average weight for the cadavers was 64.9 kg (61.2-71.7 kg). The mean procedure time was 157 min. The optimal bypassed length for the procedure was 105 cm. CONCLUSIONS This study has provided proof-of-principle in a pre-clinical cadaveric model that NOTES approach can be used to perform OAGB and, therefore, merits additional evaluation and consideration in surviving porcine model.
Collapse
Affiliation(s)
- Chin Hong Lim
- Department of Upper Gastrointestinal & Bariatric Surgery, Division of Surgery, Singapore General Hospital, Academia, 20 College Road, Singapore, 169856, Singapore.
| | - Zhen Jin Lee
- Department of Upper Gastrointestinal & Bariatric Surgery, Division of Surgery, Singapore General Hospital, Academia, 20 College Road, Singapore, 169856, Singapore
| | - Tiffany Lye
- Department of Upper Gastrointestinal & Bariatric Surgery, Division of Surgery, Singapore General Hospital, Academia, 20 College Road, Singapore, 169856, Singapore
| | - Asokkumar Ravishankar
- Department of Gastroenterology & Hepatology, Division of Medicine, Singapore General Hospital, Singapore, Singapore
| | - Baldwin Yeung
- Department of Upper Gastrointestinal & Bariatric Surgery, Sengkang General Hospital, Singapore, Singapore
| | - Hock Soo Ong
- Department of Upper Gastrointestinal & Bariatric Surgery, Division of Surgery, Singapore General Hospital, Academia, 20 College Road, Singapore, 169856, Singapore
| | - Jeremy Tan
- Department of Upper Gastrointestinal & Bariatric Surgery, Division of Surgery, Singapore General Hospital, Academia, 20 College Road, Singapore, 169856, Singapore
| |
Collapse
|
2
|
Natural orifice transluminal endoscopic one-anastomosis gastric bypass: a feasibility study using porcine model. Surg Endosc 2021; 35:5842-5851. [PMID: 34008110 DOI: 10.1007/s00464-021-08547-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 05/04/2021] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Endoscopic bariatric therapies (EBT) are emerging as effective therapies in the management of overweight patient with or without metabolic syndrome. Unfortunately most procedures only restrict the gastric volume without altering the underlying metabolism which is seen in surgical patients. The aim of this study was to investigate the feasibility and limitations of a natural orifice trans-luminal endoscopic surgery (NOTES) one anastomosis gastric bypass (OAGB). METHODS NOTES OAGB was performed in three porcine models. The steps of the procedure can be divide as follows: (1) Endoscopic sleeve gastroplasty. (2) Trans-gastric access to peritoneal cavity. (3) Identification of a loop of jejunum. (4) Introduction of the jejunal loop into the stomach. (5) Creation of the gastro-jejunostomy with lumen-apposing metal stent (LAMS). (6) Closure of gastric pylorus with overstitch system. RESULTS All the animals underwent successful NOTES of OAGB. The mean weight for the animals was 34.3 kg (32-37 kg). The mean procedure time was 250 min (300 min for first animal and 180 min for third animal). The average bypassed bilio-pancreatic limb was 98 cm (range 65-130 cm). CONCLUSIONS This study has provided proof-of-principle in a preclinical model that a NOTES approach can be used to perform OAGB and, therefore, merits additional evaluation and consideration.
Collapse
|
3
|
Erridge S, Sodergren MH, Darzi A, Purkayastha S. Natural Orifice Translumenal Endoscopic Surgery: Review of Its Applications in Bariatric Procedures. Obes Surg 2015; 26:422-8. [PMID: 26620212 PMCID: PMC4709375 DOI: 10.1007/s11695-015-1978-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
This review aims to summarise clinical applications of natural orifice translumenal endoscopic surgery (NOTES) in bariatric surgery. A review of data, until December 2014, was carried out regarding techniques and outcomes of bariatric NOTES procedures. Nine publications were included in the final analysis, with another six papers describing endolumenal procedures included for comparison. All NOTES studies adopted a hybrid procedure. Hybrid NOTES sleeve gastrectomy (hNSG) was described in four humans and two porcine studies. In humans, six subjects (23.1 %) were converted to conventional laparoscopic methods, and one postoperative complication (3.8 %) was reported. Mean excess weight loss was 46.6 % (range 35.2–58.9). Transvaginal-assisted sleeve gastrectomy appears feasible and safe when performed by appropriately trained professionals. However, improvements must be made to overcome current technical limitations.
Collapse
Affiliation(s)
- Simon Erridge
- Department of Surgery and Cancer, Imperial College London, London, UK.
| | | | - Ara Darzi
- Department of Surgery and Cancer, Imperial College London, London, UK.
| | | |
Collapse
|
4
|
Thakkar S, Awad M, Gurram KC, Tully S, Wright C, Sanan S, Choset H. A novel, new robotic platform for natural orifice distal pancreatectomy. Surg Innov 2014; 22:274-82. [PMID: 25320108 DOI: 10.1177/1553350614554232] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Laparoendoscopic technology has revolutionized the practice of surgery; however, surgeons have not widely accepted laparoscopic techniques for pancreatic surgeries due to the complexity of the operation. Natural orifice transluminal endoscopic surgery (NOTES) offers a great new potential for pancreatic procedures, with early data showing benefits of reduced visible scarring and the potential for decreased wound infections, hernias, pain, and postoperative complications. However, there are significant limitations to the currently used flexible endoscopy tools, including a diminished visual field, spatial orientation and tissue manipulation issues, and 2-dimensional visual feedback. We have adopted a novel snake-like robot, the minimally invasive cardiac surgery (MICS) robot, which addresses these issues. In the current pilot study, the MICS robot was evaluated for transrectal distal pancreas exploration and resection in 2 nonsurvival porcine models. Abdominal navigation and accessing the pancreas was investigated in the first pig, and based on its success, pancreas resection was studied in pig 2. The MICS robot was successful in accessing and visualizing the right upper, left upper, and left lower quadrants of the abdomen in pig 1 and was able to perform a successful complex NOTES procedure with distal pancreas resection in pig 2, with only minimal laparoscopic retraction assistance. In conclusion, preliminary results showing the MICS robot in natural orifice distal pancreatectomy are positive. Enhancements to optics and instrumentation will help further increase the usability in pancreatic interventions. Future indications may include transgastric NOTES approaches, endoluminal procedures, and single-port applications.
Collapse
Affiliation(s)
- Shyam Thakkar
- West Penn Allegheny Health System, Pittsburgh, PA, USA
| | | | | | | | | | | | | |
Collapse
|
5
|
Rashti F, Gupta E, Ebrahimi S, Shope TR, Koch TR, Gostout CJ. Development of minimally invasive techniques for management of medically-complicated obesity. World J Gastroenterol 2014; 20:13424-13445. [PMID: 25309074 PMCID: PMC4188895 DOI: 10.3748/wjg.v20.i37.13424] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Revised: 06/15/2014] [Accepted: 07/16/2014] [Indexed: 02/06/2023] Open
Abstract
The field of bariatric surgery has been rapidly growing and evolving over the past several decades. During the period that obesity has become a worldwide epidemic, new interventions have been developed to combat this complex disorder. The development of new laparoscopic and minimally invasive treatments for medically-complicated obesity has made it essential that gastrointestinal physicians obtain a thorough understanding of past developments and possible future directions in bariatrics. New laparoscopic advancements provide patients and practitioners with a variety of options that have an improved safety profile and better efficacy without open, invasive surgery. The mechanisms of weight loss after bariatric surgery are complex and may in part be related to altered release of regulatory peptide hormones from the gut. Endoscopic techniques designed to mimic the effects of bariatric surgery and endolumenal interventions performed entirely through the gastrointestinal tract offer potential advantages. Several of these new techniques have demonstrated promising, preliminary results. We outline herein historical and current trends in the development of bariatric surgery and its transition to safer and more minimally invasive procedures designed to induce weight loss.
Collapse
|
6
|
Porzionato A, Polese L, Lezoche E, Macchi V, Lezoche G, Da Dalt G, Stecco C, Norberto L, Merigliano S, De Caro R. On the suitability of Thiel cadavers for natural orifice transluminal endoscopic surgery (NOTES): surgical training, feasibility studies, and anatomical education. Surg Endosc 2014; 29:737-46. [PMID: 25060684 DOI: 10.1007/s00464-014-3734-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2013] [Accepted: 07/07/2014] [Indexed: 12/15/2022]
Abstract
BACKGROUND Surgical training in virtual, animal and cadaver models is essential for minimally invasive surgery. Thiel cadavers are suitable for laparoscopy, but there are few data about the use of embalmed (Tutsch method) and slightly embalmed (Thiel method) cadavers in procedures of Natural Orifice Transluminal Endoscopic Surgery (NOTES), which are usually developed and learned on swine models and fresh frozen cadavers. The aim of this study was thus to assess the use of these cadavers for NOTES approaches. METHODS The following surgical procedures were evaluated: transanal total mesorectal excision (four cadavers: one Tutsch, two Thiel, one fresh frozen), transanal ileorectal bypass (five cadavers: one Tutsch, three Thiel, one fresh frozen), and transvaginal appendectomy (two Tutsch cadaver). RESULTS The Thiel method ensured tissue flexibility and consistency suitable for performing the above surgical procedures with good results and without complications, with only a small increase in rigidity with respect to fresh specimens. Cadavers embalmed with higher formalin concentrations (Tutsch method) were more difficult to use, due to high tissue rigidity and resistance of the abdominal wall to pneumoperitoneum, although NOTES accesses were possible. CONCLUSIONS Thiel cadavers are suitable for transanal/transrectal and transvaginal NOTES approaches, for training surgical residents/specialists and also for surgical research. In minimally invasive surgery (and particularly in NOTES), integration between cadaver (fresh frozen and/or Thiel) and animal models would represent the gold standard, allowing guaranteed knowledge of and respect for human surgical anatomy and correct management of surgery on living subjects. NOTES approaches to human cadavers may also be proposed for the anatomical education of medical students.
Collapse
Affiliation(s)
- Andrea Porzionato
- Section of Anatomy, Department of Molecular Medicine, University of Padova, Via A. Gabelli 65, 35127, Padua, Italy
| | | | | | | | | | | | | | | | | | | |
Collapse
|
7
|
Gonzalez JM, Bonin EA, Vanbiervliet G, Garnier E, Berdah S, Matthes K, Barthet M. Evaluation of feasibility, efficiency and safety of a pure NOTES gastrojejunal bypass with gastric outlet obstruction, in an in vivo porcine model. Endosc Int Open 2013; 1:31-8. [PMID: 26135510 PMCID: PMC4440371 DOI: 10.1055/s-0033-1353686] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Accepted: 12/05/2013] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Natural orifice transluminal endoscopic surgery (NOTES) gastrojejunal anastomosis (GJA) is a less invasive surgery for bariatric procedures and gastric outlet obstruction. The aim of this study was to evaluate the feasibility, efficacy, and safety of a pure NOTES gastrojejunal bypass using an in vivo porcine model. MATERIAL AND METHODS A prospective study was performed on nine swine. A double-channel scope was used. The intervention steps were: (i) gastric incision; (ii) peritoneal access; (iii) jejunal loop selection and mobilization into the stomach; (iv) stoma creation within the gastric wall and incision; (v) anastomosis suture and pylorus closure using a T-tag prototype. The animals were assessed clinically for 3 weeks including the weight gain. The patency of the GJA was assessed at necropsy and a histological analysis was performed. RESULTS We successfully performed all the procedures with a mean (standard deviation [SD]) operative time of 108 (26) minutes. We used a mean of 5.55 (1.30) stitches. There were no intraprocedural adverse events. Five animals survived up till euthanasia at 3 weeks (65 %). These showed a significant difference in weight curves of a loss of 3.2 kg compared with gain of 5.2 kg in a control group. Four pigs died from anastomotic dehiscence complicated by peritonitis. CONCLUSION Gastrojejunal bypass with a pure NOTES approach is feasible. This procedure is effective, resulting in a patent anastomosis and a significant weight loss. However, the anastomotic dehiscence is a major concern because of its mortality rate, and further studies including improvement of the suturing device and the technique are needed.
Collapse
Affiliation(s)
- J.-M. Gonzalez
- Department of Gastroenterology, Public Assistance Hospitals of Marseille, North Hospital, Marseille, France,Department of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States,Corresponding author Dr. Jean-Michel Gonzalez, MD Laboratory Dana 506Department of GastroenterologyBeth Israel Deaconess Medical CenterHarvard Medical SchoolBoston, MAUnited States
| | - E. A. Bonin
- Department of Gastroenterology, Public Assistance Hospitals of Marseille, North Hospital, Marseille, France
| | - G. Vanbiervliet
- Department of Endoscopy, University Hospital of Nice, Nice, France
| | - E. Garnier
- Aix-Marseille University, CERC, Faculty of Medicine, Marseille, France
| | - S. Berdah
- Department of Digestive Surgery, Public Assistance Hospitals of Marseille, Marseille, France
| | - K. Matthes
- Department of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States
| | - M. Barthet
- Department of Gastroenterology, Public Assistance Hospitals of Marseille, North Hospital, Marseille, France
| |
Collapse
|
8
|
Vanbiervliet G, Gonzalez JM, Bonin EA, Garnier E, Giusiano S, Saint Paul MC, Berdah S, Barthet M. Gastrojejunal Anastomosis Exclusively Using the "NOTES" Technique in Live Pigs: A Feasibility and Reliability Study. Surg Innov 2013; 21:409-18. [PMID: 24253256 DOI: 10.1177/1553350613508016] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Natural orifice transluminal endoscopic surgery (NOTES) could reduce procedure-associated morbidity and mortality. The aim of this study was to determine the feasibility of performing a simple model of gastrojejunal anastomosis in a living porcine model exclusively using NOTES. METHODS It was a prospective experimental animal study concerning pigs weighing between 25 and 30 kg. Endoscopies were performed using a double-channel gastroscope. A preliminary phase allowed for the development of the technique on 3 animals that were immediately euthanized. The experimental phase included the implementation of a gastrojejunal anastomosis in 9 animals. Antibiotic therapy was continued for 7 days with gradual feeding. Surviving animals were euthanized after 3 weeks. Anastomosis permeability in each animal was confirmed by opacification, endoscopy, and histopathological analysis. The main outcome measurements were the feasibility and animal survival at 3 weeks postsurgery. RESULTS The entire procedure was performed on 9 animals (4 males and 5 females). Anastomosis required 4.7 ± 1.2 stitches (range 4-7). The average total length of the procedure was 143 ± 50.8 minutes (range 87-225 minutes). One bleeding, 2 suture dehiscences, and a poor stomach incision were the immediate complications endoscopically resolved. At 3 weeks, 5 animals had survived. Three animals died as a result of anastomotic leakage confirmed at necropsy and histopathology. In the surviving animals, histology confirmed permeable anastomoses with collagen scar tissue and continuity of the mucosa and mucosa muscle layers. CONCLUSION Successful gastrojejunal anastomosis by NOTES is technically feasible but is subject to a learning curve.
Collapse
Affiliation(s)
- Geoffroy Vanbiervliet
- University of Nice Sophia-Antipolis, Nice, France University Hospital of Nice, Nice, France Laboratoire de Biomécanique Appliquée, UMRT24 IFSTTAR/Aix-Marseille University, France
| | - Jean-Michel Gonzalez
- Laboratoire de Biomécanique Appliquée, UMRT24 IFSTTAR/Aix-Marseille University, France Public Assistance Hospitals of Marseille, Marseille, France
| | - Eduardo Aimore Bonin
- Laboratoire de Biomécanique Appliquée, UMRT24 IFSTTAR/Aix-Marseille University, France Public Assistance Hospitals of Marseille, Marseille, France
| | - Emmanuelle Garnier
- Laboratoire de Biomécanique Appliquée, UMRT24 IFSTTAR/Aix-Marseille University, France
| | - Sophie Giusiano
- Laboratoire de Biomécanique Appliquée, UMRT24 IFSTTAR/Aix-Marseille University, France Public Assistance Hospitals of Marseille, Marseille, France
| | | | - Stéphane Berdah
- Laboratoire de Biomécanique Appliquée, UMRT24 IFSTTAR/Aix-Marseille University, France Public Assistance Hospitals of Marseille, Marseille, France
| | - Marc Barthet
- Laboratoire de Biomécanique Appliquée, UMRT24 IFSTTAR/Aix-Marseille University, France Public Assistance Hospitals of Marseille, Marseille, France
| |
Collapse
|
9
|
Denzer UW, von Renteln D, Lübke A, Heinemann A, Rösch T, Püschel K, Karbe T. Minimally invasive autopsy by using postmortem endoluminal and transluminal endoscopy and EUS. Gastrointest Endosc 2013; 78:774-80. [PMID: 24021488 DOI: 10.1016/j.gie.2013.07.036] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Accepted: 07/20/2013] [Indexed: 02/05/2023]
Abstract
BACKGROUND Virtual autopsy by using CT imaging has been introduced as an alternative to conventional autopsy and has resulted in an increase in acceptance of autopsy by relatives. Because direct inspection and tissue acquisition is not possible by imaging alone, various endoscopic techniques can be considered of complementary usefulness. OBJECTIVES We present the first series of sequential endoscopic techniques including natural orifice transluminal access for minimally invasive autopsy. SETTING University hospital, legal medicine department. SUBJECTS Twenty deceased subjects. INTERVENTION Various flexible endoscopic modalities including EUS, with biopsy or EUS-guided FNA, were attempted. This included transluminal intra-abdominal endoscopic exploration with tissue sampling in a few cases. MAIN OUTCOME MEASUREMENTS Completeness of inspection of the luminal and extraluminal cavity as well as tissue acquisition. RESULTS Complete upper GI endoscopy was performed in 17 of 20 and EUS in 8 of 8 cases. In addition, transgastric intra-abdominal endoscopy was successfully performed in 5 cases. Adequate histology from biopsy and EUS-guided puncture could be obtained in case of short time intervals post mortem. In 1 case, a rupture of the gastric cardia with bleeding was diagnosed as a significant unexpected finding. New minor pathological findings were revealed on EGD (6/17), GI EUS (3/8), and transgastric inspection (4/5). LIMITATIONS Limited number of cases for all procedures. CONCLUSION Minimally invasive autopsy by using multiple endoscopic techniques for imaging and tissue acquisition is feasible. The significant value of this technique, in combination with virtual autopsy compared with classic autopsy, warrants further evaluation.
Collapse
Affiliation(s)
- Ulrike W Denzer
- Department of Interdisciplinary Endoscopy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | | | | | | | | | | |
Collapse
|
10
|
Mori H, Rafiq K, Kobara H, Fujihara S, Nishiyama N, Oryuu M, Suzuki Y, Masaki T. Innovative noninsufflation EFTR: sufficient endoscopic operative field by mechanical counter traction device. Surg Endosc 2013; 27:3028-34. [PMID: 23407912 DOI: 10.1007/s00464-013-2846-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2012] [Accepted: 01/07/2013] [Indexed: 01/14/2023]
Abstract
BACKGROUND No reliable pure natural orifice transluminal endoscopic surgery (NOTES) mechanical counter traction (MCT) device for the flexible endoscope to obtain a sufficient surgical endoscopic field has yet been developed. Our experience with 10 cases of hybrid NOTES prompted the realization of the importance of an MCT device for the flexible endoscope and inspired us to establish innovative noninsufflation endoscopic full-thickness resection (EFTR) with an MCT device. METHODS We performed 40 EFTR 40 mm in diameter on excised whole porcine stomachs. Twenty were resected by an MCT device to obtain a surgical field (MCT group), and another 20 were resected with a conventional endoscopic attachment (control group). We evaluated the successful resection rates of EFTR and procedure times between two groups. Next, we implemented EFTR with a custom prototype MCT device in three cases of stomach pseudotumors in female dogs. Gastric pseudotumors ~40 mm in diameter were marked within the open surgical field created by the MCT device. After resecting the pseudotumors, we conducted full-thickness suturing using over-the-scope clips. RESULTS In the MCT group, all 20 cases were completely resected. On the other hand, in the control group, only 8 cases were performed via EFTR (P < 0.01). The mean ± standard deviation EFTR procedure times for the MCT and control groups were 4.13 ± 0.824 and 36.26 ± 8.67 min, respectively (P = 0.001). In three dogs, sufficient surgical working spaces were obtained up to 78 mm (range, 65-78 mm), and full-thickness resections were performed safely and sutured with over-the-scope clips. CONCLUSIONS Our new prototype MCT device effectively obtains a sufficient surgical endoscopic field during EFTR. We are developing a new MCT with a bending function to perform EFTR in any location in the stomach.
Collapse
Affiliation(s)
- Hirohito Mori
- Department of Gastroenterology, Kagawa University Medicine School, 1750-1 Ikenobe, Kita, Miki, 761-0793 Kagawa, Japan.
| | | | | | | | | | | | | | | |
Collapse
|
11
|
Panait L, Wood SG, Bell RL, Duffy AJ, Roberts KE. Transvaginal natural orifice transluminal endoscopic surgery in the morbidly obese. Surg Endosc 2013; 27:2625-9. [PMID: 23355168 DOI: 10.1007/s00464-012-2775-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2012] [Accepted: 12/12/2012] [Indexed: 01/05/2023]
Abstract
BACKGROUND The objective of this study is to assess the safety and efficacy of transvaginal (TV) natural orifice transluminal endoscopic surgery (NOTES) operations in morbidly obese patients. METHODS One hundred seven NOTES operations have been performed at our institution to date, of which 17 were completed in patients with body mass index (BMI) between 35 and 45 kg/m(2). These included 14 cholecystectomies, one appendectomy, and two ventral hernia repairs. The patients had average age of 36.2 years (range 19-62 years) and average BMI of 38.9 kg/m(2) (range 35.2-44.9 kg/m(2)). The mean number of previous abdominal operations was 1. The TV cholecystectomies were hybrid NOTES procedures, while TV appendectomy and ventral hernia repair were pure NOTES. All operations were completed with standard straight laparoscopic instruments. RESULTS The mean operative time was 60 min for cholecystectomy, 41 min for TV appendectomy, and 90 min for ventral hernia repair. No significant difference was encountered between the operative time for NOTES cholecystectomies in obese versus nonobese (60 vs. 61 min, p = 0.86). No conversions to traditional laparoscopy or open surgery were made, and no major complications were encountered. CONCLUSIONS NOTES is an attractive alternative to laparoscopy in female patients with morbid obesity. The procedures are safe and have short operative times, good postoperative outcomes, and improved cosmesis compared with laparoscopy.
Collapse
Affiliation(s)
- Lucian Panait
- Department of Surgery, Yale School of Medicine, 40 Temple St., Suite 7B, New Haven, CT 06510, USA
| | | | | | | | | |
Collapse
|
12
|
Abstract
Rather than being an end point in and of itself, NOTES offers an approach that encompasses the potential use of a natural orifice in conjunction with flexible instruments as a less invasive and more cosmetically appealing method of performing certain surgical procedures. Gastric surgery through natural orifices is one of the cutting-edge procedures in the evolving field of NOTES. The potential indications for NOTES involve a wide spectrum of upper gastrointestinal diseases, including achalasia, reflux disease, submucosal tumors, cancer, and morbid obesity. Although NOTES is becoming more widely used, most studies still involve only small numbers of patients, and the design of larger series and comparative trials to evaluate the early indications and results of NOTES is needed.
Collapse
|
13
|
Laparoendoscopic single-site adjustable gastric banding: technical considerations. Surg Laparosc Endosc Percutan Tech 2012; 21:e295-300. [PMID: 22146175 DOI: 10.1097/sle.0b013e31823acd93] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
PURPOSE Recently, laparoendoscopic single-site surgery (LESS) has been proposed to minimize the invasiveness of laparoscopic surgery. We present our standardized technique of LESS adjustable gastric banding. METHODS Data of 25 patients who underwent LESS adjustable gastric banding between March 2009 and January 2010 was reviewed retrospectively. All procedures were performed with multiple low-profile trocars through a single incision using conventional laparoscopic instruments. RESULTS Mean operative time was 78 minutes. Mean blood loss was 8 mL and the median stay was 0.3 days (range, 0.1 to 3 d). No mortality was noted and there was 1 reoperation in the perioperative period due to stoma obstruction. CONCLUSIONS LESS adjustable gastric banding with traditional rigid instruments is feasible and safe but requires working with limited triangulation. Short-term outcomes are promising but long-term follow-up is needed in weighing in the potential benefits to the patient against the technical challenges that arise with this technique.
Collapse
|
14
|
Abstract
Bariatric surgery is a field in rapid evolution, and the speed of this evolution has been accelerating over the last several decades. A thorough understanding of past developments is crucial to anticipating the future intelligently. The trends that have driven evolution historically often persist, and continue to be influential in the future. With this in mind, this article briefly outlines the historical and current trends in bariatric surgery, and follows the trajectory of these trends into the future to anticipate the technologies and techniques that will be most important to the field in the coming years.
Collapse
Affiliation(s)
- Sean M Lee
- Department of Surgery, Duke University Medical Center, Box 3443, Durham, NC 27710, USA
| | | |
Collapse
|
15
|
Michalik M, Orlowski M, Bobowicz M, Frask A, Trybull A. The first report on hybrid NOTES adjustable gastric banding in human. Obes Surg 2011; 21:524-7. [PMID: 20354810 DOI: 10.1007/s11695-010-0130-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Despite their current limitations, metabolic surgery and natural orifice transluminal endoscopic surgery (NOTES), set new horizons. In this article, the first three cases of adjustable gastric banding (AGB) through transvaginal access in obese women are described. METHODS In the General and Vascular Surgery Department, Ceynowa Hospital, Poland, three cases of AGB through the transvaginal access in hybrid, laparoscopically assisted NOTES technique were performed. All patients were female with BMI range 35-37. A dual-channel endoscope and regular laparoscopic instruments were used. RESULTS The mean operating time was 110 min. Indometacin was given intravenously PRN for postoperative pain. None of the patients required more than 3 g of indometacin and for longer than 24 h postoperatively. None required opioids either. There was one major complication of iatrogenic damage to the ureter, which required subsequent hospitalisation and laparoscopic repair. Hospitalisation time was 2 days. During 2 months follow up, the mean weight loss was 15 kg. There were no malpositions of the band. There was no early mortality in the study group. CONCLUSION Feasibility of the proposed hybrid laparoscopically assisted NOTES adjustable gastric banding was proved. It is a technically demanding procedure, requiring appropriate endoscopic and laparoscopic skills. To avoid ureteric damage one should acquire safe colpotomy skills before commencing transvaginal NOTES operations.
Collapse
Affiliation(s)
- Maciej Michalik
- General and Vascular Surgery Department, Ceynowa Hospital, Jagalskiego 10, Wejherowo, 84-200, Poland.
| | | | | | | | | |
Collapse
|
16
|
Chouillard EK, Al Khoury M, Bader G, Heitz D, Elrassi Z, Fauconnier A. Combined vaginal and abdominal approach to sleeve gastrectomy for morbid obesity in women: a preliminary experience. Surg Obes Relat Dis 2010; 7:581-6. [PMID: 21126921 DOI: 10.1016/j.soard.2010.09.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2010] [Revised: 09/20/2010] [Accepted: 09/25/2010] [Indexed: 12/15/2022]
Abstract
BACKGROUND Natural orifice translumenal endoscopic surgery is an emerging surgical phenomenon. Although the development of "pure" natural orifice translumenal endoscopic surgical techniques in humans has been slowed by major technical hurdles, "hybrid" or combined variants have been increasingly reported. Laparoscopic sleeve gastrectomy (SG) is a commonly performed treatment of morbid obesity. We have developed a combined variant of SG for patients with morbid obesity. Our aim was to assess the feasibility and safety of such an approach, which could eventually reduce the postoperative pain, preserve the abdominal wall, and enhance cosmesis. METHODS Combined, transvaginal and abdominal SG was attempted in 20 patients. The inclusion criteria were morbid obesity (body mass index <50 kg/m(2)), female gender, an absence of gynecologic disorders, and the absence of major previous abdominal surgery. The local ethical committee approved the present study. The technique was performed using a vaginal incision with 1 or 2 abdominal ports. RESULTS The procedure was a success in 14 patients (70%). In 6 patients, conversion to a more conventional laparoscopic SG was required, with ≥ 1 abdominal ports added. The mean operative time was 116 minutes (range 54-231). The postoperative complication rate was 5% (1 patient developed pneumonia). No hemorrhage, surgical site infection, or fistula was encountered. The mean length of hospital stay was 72 hours (range 24-144). CONCLUSION Our combined, transvaginal and abdominal variant of laparoscopic SG was sure and feasible in a small series of selected patients with morbid obesity.
Collapse
Affiliation(s)
- Elie K Chouillard
- Department of Minimally Invasive and Digestive Surgery, Poissy/Saint-Germain Mediacl Center, Poissy, France.
| | | | | | | | | | | | | |
Collapse
|
17
|
Gillen S, Kleeff J, Kranzfelder M, Shrikhande SV, Friess H, Feussner H. Natural orifice transluminal endoscopic surgery in pancreatic diseases. World J Gastroenterol 2010; 16:3859-64. [PMID: 20712045 PMCID: PMC2923758 DOI: 10.3748/wjg.v16.i31.3859] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Natural orifice transluminal endoscopic surgery (NOTES) is a surgical technique that has received considerable interest in recent years. Although minimal access surgery has increasingly replaced traditional open abdominal surgical approaches for a wide spectrum of indications, in pancreatic diseases its widespread use is limited to few indications because of the challenging and demanding nature of major pancreatic operations. Nonetheless, there have been attempts in animal models as well as in the clinical setting to perform diagnostic and resectional NOTES for pancreatic diseases. Here, we review and comment upon the available data regarding currently analyzed and performed pancreatic NOTES procedures. Potential indications for NOTES include peritoneoscopy, cyst drainage, and necrosectomy, palliative procedures such as gastroenterostomy, as well as resections such as distal pancreatectomy or enucleation. These procedures have already been shown to be technically feasible in several studies in animal models and a few clinical trials. In conclusion, NOTES is a rapidly developing concept/technique that could potentially become an integral part of the armamentarium dealing with surgical approaches to pancreatic diseases.
Collapse
|
18
|
|
19
|
Saber AA, Elgamal MH, El-Ghazaly TH, Elian AR, Dewoolkar AV, Akl AH. Three trocar laparoscopic Roux-en-y gastric bypass: A novel technique en route to the single-incision laparoscopic approach. Int J Surg 2010; 8:131-4. [DOI: 10.1016/j.ijsu.2009.11.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2009] [Revised: 11/04/2009] [Accepted: 11/20/2009] [Indexed: 01/23/2023]
|
20
|
Lukovich P. [NOTES (Natural Orifice Translumenal Endoscopic Surgery)]. Magy Seb 2009; 62:274-278. [PMID: 19679539 DOI: 10.1556/maseb.62.2009.4.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
|