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Trends in Minimally Invasive Approaches for Liver Resections-A Systematic Review. J Clin Med 2022; 11:jcm11226721. [PMID: 36431199 PMCID: PMC9697421 DOI: 10.3390/jcm11226721] [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] [Received: 10/12/2022] [Revised: 11/01/2022] [Accepted: 11/10/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND SILS (single incision laparoscopic surgery) and NOTES (natural orifice transluminal endoscopic surgery) are considered breakthroughs in minimally invasive surgery, the first consisting in the surgeon working via a single entrance site and the second via a natural orifice (e.g., oral cavity). METHODS Since 2000 until 2022, the original articles published in the online databases were analyzed. Eligible studies included information about the current therapy of patients with liver surgical pathology and how the two new techniques improve the surgical approach. RESULTS A total of 798 studies were identified. By applying the exclusion criteria, nine studies remained to be included in the review. Two out of nine studies examined the NOTES approach in liver surgery, whereas the other seven focused on the SILS technique. The age of the patients ranged between 24 and 83 years. Liver resections for hepatocellular carcinoma or colorectal metastases were undertaken and biliary or hydatid cysts were removed. The mean procedure time was 95 to 205 min and the average diameter of the lesions was 5 cm. CONCLUSIONS When practiced by multidisciplinary teams, transvaginal liver resection is feasible and safe. The goals of SILS and NOTES are to be less intrusive, more easily tolerated and aesthetic.
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Hu K, Ke Y, Chen Q, Wu J, Ke Y, Xie Q, Liu B, Chen J. Case report: dual primary malignancies treated by laparoscopic multiorgan resection with natural orifice specimen extraction surgery. Front Oncol 2022; 12:916104. [PMID: 35965528 PMCID: PMC9372278 DOI: 10.3389/fonc.2022.916104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 07/07/2022] [Indexed: 11/13/2022] Open
Abstract
With microtrauma becoming a consensus, in order to improve surgical treatment capability, the clinical application of laparoscopic multiorgan resection is becoming more and more complicated and diversified. Recently, we successfully presented a case of transvaginal specimen extraction surgery that included laparoscopic anatomical left hemihepatectomy combined with laparoscopic total hysterectomy and bilateral adnexectomy and the pelvic and para-aortic lymphadenectomy. The patient, a 75-year-old woman, was hospitalized with abnormal vaginal discharge and bleeding. The pathologic diagnosis of uterine curettage was endometrioid adenocarcinoma. After completing examinations such as color Doppler ultrasound, CEUS, MRCP and thoracoabdominal enhanced spiral CT, preoperative diagnosis was considered as endometrial cancer and a space-occupying lesion in the liver (primary or secondary site)?. No lymphatic or distant metastasis had been found. We also excluded Lynch syndrome by digestive endoscopy and gene sequencing. After a multidisciplinary consultation, the patient underwent surgery under general anesthesia on 24 September 2021. The operation was completed uneventfully in 6 hours, then the patient was transferred to the ICU for follow-up monitoring. The patient began to eat and was able to leave bed on the 4th postoperative day. According to immunohistochemistry, the patient's postoperative diagnosis was intrahepatic cholangiocarcinoma (ICC) and endometrial cancer. Compared with open surgery, laparoscopic multiorgan resection with natural orifice specimen extraction surgery (NOSES) has many advantages such as fewer traumas, shorter recovery time, and better postoperative quality of life. However, combined large-scale laparoscopic surgeries of different organs can be challenging for surgeons and anesthesiologists. No similar cases have been searched.
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Affiliation(s)
- Kunpeng Hu
- Department of General Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
- Department of General Surgery, Chaozhou Central Hospital, Chaozhou, China
| | - Yifan Ke
- Department of General Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Qin Chen
- Department of General Surgery, Chaozhou Central Hospital, Chaozhou, China
| | - Jiezhong Wu
- Department of General Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Yingping Ke
- Department of General Surgery, Chaozhou Central Hospital, Chaozhou, China
| | - Qiuxian Xie
- Department of Gynecology, Chaozhou Central Hospital, Chaozhou, China
| | - Bo Liu
- Department of General Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Jiajia Chen
- Department of General Surgery, Chaozhou Central Hospital, Chaozhou, China
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Hurni Y, Romito F, Huber DE. Is transvaginal natural orifice transluminal endoscopic surgery (vNOTES) indicated in patients with previous extensive pelvic surgeries? A case report. Case Rep Womens Health 2022; 34:e00397. [PMID: 35198415 PMCID: PMC8851094 DOI: 10.1016/j.crwh.2022.e00397] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 02/07/2022] [Accepted: 02/08/2022] [Indexed: 11/28/2022] Open
Abstract
Transvaginal natural orifice transluminal endoscopic surgery (vNOTES) has been increasingly applied to perform multiple gynecologic procedures. However, evidence is lacking on whether this surgical approach is feasible for patients with prior extensive abdominopelvic surgeries. We report a case of prophylactic bilateral salpingo-oophorectomy (BSO) performed in a 51-year-old patient with previous laparotomic radical hysterectomy and pelvic lymphadenectomy for cervical cancer. The patient underwent rectovaginal examination and evaluation of the transvaginal sonographic sliding sign as preoperative screening to exclude the obliteration of the pouch of Douglas. The abdominal cavity was accessed by cautious endoscopic access to the pouch of Douglas. The BSO was realized in accordance with risk-reducing surgery guidelines. No intraoperative or postoperative complications were observed. We suggest that selecting patients carefully prior to operation and adapting intraoperative techniques could be a safe method for conducting vNOTES interventions in patients with extensive abdominopelvic adhesions.
vNOTES has been increasingly applied to perform multiple gynecologic procedures. There is a lack of evidence for its feasibility for patients who have previously had extensive surgery. Careful preoperative evaluations and intraoperative adaptations are needed. Extensive pelvic adhesiolysis by vNOTES appears feasible. We report a vNOTES intervention in a patient with previous extensive surgery.
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Affiliation(s)
- Yannick Hurni
- Department of Pediatrics, Gynecology and Obstetrics, Geneva University Hospitals, Boulevard de la Cluse 30, 1205 Geneva, (Switzerland)
- Department of Gynecology and Obstetrics, Valais Hospital, Av. du Grand-Champsec 80, 1951 Sion, Switzerland
- Corresponding author at: Department of Gynecology and Obstetrics, Valais Hospital, Av. du Grand-Champsec 80, 1951 Sion, Switzerland.
| | - Fabien Romito
- Department of Gynecology and Obstetrics, Valais Hospital, Av. du Grand-Champsec 80, 1951 Sion, Switzerland
| | - Daniela Emanuela Huber
- Department of Pediatrics, Gynecology and Obstetrics, Geneva University Hospitals, Boulevard de la Cluse 30, 1205 Geneva, (Switzerland)
- Department of Gynecology and Obstetrics, Valais Hospital, Av. du Grand-Champsec 80, 1951 Sion, Switzerland
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Liu BR, Ullah S, Li DL, Liu D, Zhao LX, Yang W, Kong LJ, Zhang JY. A snare-assisted pure NOTES retrograde cholecystectomy using a single channel flexible endoscope: a pilot experiment in a porcine model. Surg Endosc 2020; 34:3706-3710. [DOI: 10.1007/s00464-020-07561-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 04/10/2020] [Indexed: 02/07/2023]
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Ersan V, Kayaalp C, Aktas A, Gundogan E, Teomete U, Sumer F, Karagul S. Transvaginal extraction of laparoscopic liver resection specimen. Interv Med Appl Sci 2018; 9:215-217. [PMID: 29951289 PMCID: PMC6016203 DOI: 10.1556/1646.9.2017.39] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
The application of laparoscopic surgery via the vagina has been introduced at the beginning of this millennium. Here, we report a case of transvaginal extraction of a laparoscopic hepatectomy specimen. An exophytic liver mass originated from segment VI in a 24-year-old female was excised with laparoscopic technique using four trocars (0.5–1.2 cm sizes). The specimen (11 × 8.5 cm) was removed transvaginally instead of an abdominal incision. To the best of our knowledge, only six similar cases have been previously reported, with a patient age range of 32–74 years. Our case, due to younger age, had high cosmetic expectations. Specific to this case, we aimed a better aesthetic outcomes and better convalescence period and, we achieved these objectives. We believe that patient selection and experience on natural orifice specimen extraction were the keys to the success of the operation. We shared this technique with a video presentation.
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Affiliation(s)
- Veysel Ersan
- Department of Surgery, Inonu University School of Medicine, Malatya, Turkey
| | - Cuneyt Kayaalp
- Department of Surgery, Inonu University School of Medicine, Malatya, Turkey
| | - Aydin Aktas
- Department of Surgery, Inonu University School of Medicine, Malatya, Turkey
| | - Ersin Gundogan
- Department of Surgery, Inonu University School of Medicine, Malatya, Turkey
| | - Uygar Teomete
- Department of Radiology, Miami University, Coral Gables, FL, USA
| | - Fatih Sumer
- Department of Surgery, Inonu University School of Medicine, Malatya, Turkey
| | - Servet Karagul
- Department of Surgery, Inonu University School of Medicine, Malatya, Turkey
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Feasibility and Technique for Transvaginal Natural Orifice Transluminal Endoscopic Surgery Liver Resection: A Porcine Model. Surg Laparosc Endosc Percutan Tech 2017; 27:e6-e11. [PMID: 28030435 PMCID: PMC5287436 DOI: 10.1097/sle.0000000000000367] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Natural orifice transluminal endoscopic surgery (NOTES) is a challenging minimally invasive procedure. Although laparoscopic techniques for liver resection are gaining acceptance worldwide, few studies have investigated NOTES liver resection. We used a porcine model to assess the feasibility and safety of transvaginal NOTES liver resection (TV NOTES LR). MATERIALS AND METHODS Nine female pigs underwent TV NOTES LR. A nonsurvival acute porcine model with general anesthesia was used in all cases. Using hybrid NOTES technique, we placed only 1 umbilical 12-mm umbilical trocar in the abdominal wall, which was used to create pneumoperitoneum. A laparoscope was then advanced to obtain intra-abdominal visualization. A 15-mm vaginal trocar was inserted under direct laparoscopic vision, and a flexible endoscope was introduced through the vaginal trocar. A long, flexible grasper and endocavity retractor were used to stably retract the liver. The liver edge was partially transected using energy devices inserted through the umbilical trocar. To transect the left lateral lobe, a flexible linear stapler was inserted alongside the vaginal trocar. A specimen extraction bag was deployed and extracted transvaginally. Blood loss, bile leakage, operative time, and specimen size were evaluated. Necropsy studies were performed after the procedures. RESULTS Eighteen transvaginal NOTES partial liver resections and 4 transvaginal NOTES left lateral lobectomies were successfully performed on 9 pigs. Mean operative time was 165.8 minutes, and mean estimated blood loss was 76.6 mL. All TV NOTES LRs were performed without complications or deaths. Necropsy showed no bile leakage from remnant liver. CONCLUSIONS Our porcine model suggests that TV NOTES LR is technically feasible and safe and has the potential for clinical use as a minimally invasive alternative to conventional laparoscopic liver resection.
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Ban D, Kudo A, Irie T, Ochiai T, Aihara A, Matsumura S, Tanaka S, Tanabe M. Advances in reduced port laparoscopic liver resection. Asian J Endosc Surg 2015; 8:11-15. [PMID: 25510567 DOI: 10.1111/ases.12164] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Revised: 10/08/2014] [Accepted: 11/09/2014] [Indexed: 12/14/2022]
Abstract
Reduced port surgery has been attracting attention in the field of minimally invasive surgery. Although the use of SILS is becoming widespread, technical difficulty has delayed its adoption for laparoscopic liver resection. Recently, advances in laparoscopic liver resection have been made in tandem with advances in surgical skill and devices. The main driver in conventional laparoscopic liver resection's evolution to become less surgically invasive seems to be single-incision laparoscopic liver resection (SILLR). To date, most reports on SILLR have been single case reports or case series. Only a few cohort studies on conventional laparoscopic surgery and SILLR have been conducted. Recent reports have described the use of SILLR for well-localized lesions and solitary tumors located in the anterolateral segments of the liver or left liver lobe, but its application remains limited to partial resection and left lateral sectionectomy. The feasibility and safety of SILLR have been demonstrated, but additional work is needed for standardization of the procedure.
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Affiliation(s)
- Daisuke Ban
- Department of Hepatobiliary-Pancreatic Surgery, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan
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Natural-orifice translumenal endoscopic surgery (NOTES): minimally invasive evolution or revolution? Surg Laparosc Endosc Percutan Tech 2014; 23:244-50. [PMID: 23751986 DOI: 10.1097/sle.0b013e31828b8b7b] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Since the first animal experimental laparoscopy in 1902, minimal access techniques have revolutionized surgery. Using the natural orifice dates back to at least the second century when Soranus performed a vaginal hysterectomy. The main difference between traditional endolumenal surgery and the translumenal approach of natural-orifice translumenal endoscopic surgery (NOTES) is the intentional puncture of a healthy organ in NOTES to access a cavity or other organ. The aim of this review was to examine the past, present, and potential future role of NOTES in the context of other developments in minimal access surgery. NOTES is at an early stage in its development and a convincing benefit over laparoscopy has not been demonstrated. Concerns regarding complications, for example of viscerotomy closure, have limited the widespread uptake of pure NOTES. However, it is likely that technological advances for NOTES surgery will enhance conventional laparoscopic and endoscopic techniques.
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Direct laryngoscopy using a videogastroscope: outcome of 119 cases. Indian J Otolaryngol Head Neck Surg 2014; 65:34-6. [PMID: 24381916 DOI: 10.1007/s12070-012-0595-5] [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: 04/19/2012] [Accepted: 11/07/2012] [Indexed: 10/27/2022] Open
Abstract
Direct laryngoscopy is an essential examination for supraglottic and laryngeal pathology. Fibreoptic or videolaryngoscope are not readily available. This study was designed to see the usefulness of Videogastroscope to evaluate laryngeal lesion instead of fibreoptic or videolaryngoscope. Patients with unsuccessful or unsatisfactory indirect laryngoscopic examination referred by ENT surgeons were examined using videogastroscope and anaesthetizing oropharynx and hypopharynx with lidocaine pharyngeal spray. Under direct supervision impressions including still and dynamic images were recorded. Study group comprised of 76 males and 43 females with age varying from 09 to 87 with mean age 44 years. Various abnormalities were detected among 74 (62.2 %) patients. Common pathologies were vocal cord polyps and nodules in 28, laryngitis and laryngeal ulcer in 16, supraglottic growth in 13 and pyriform fossa growth in 10. Direct laryngoscopy using videogastroscope is safe, effective and easily performed newer technique which might be very useful where indirect laryngoscopy is difficult and fibreoptic or videolaryngoscope is not available.
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Ramalingam M, King J, Jaacks L. Transvaginal specimen extraction after combined laparoscopic splenectomy and hysterectomy: Introduction to NOSE (Natural Orifice Specimen Extraction) in a community hospital. Int J Surg Case Rep 2013; 4:1138-41. [PMID: 24270286 PMCID: PMC3860049 DOI: 10.1016/j.ijscr.2013.07.039] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2013] [Revised: 07/27/2013] [Accepted: 07/29/2013] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Developments in the field of minimally invasive surgery have led to interest in NOTES (natural orifice transluminal endoscopic surgery). Even as technologies continue to evolve and develop, interest in some of the advantages of specimen retrieval transvaginally has been roused and we describe a case of combined laparoscopic splenectomy and hysterectomy with transvaginal retrieval of both specimens. PRESENTATION OF CASE Patient underwent laparoscopic splenectomy and robot-assisted hysterectomy with transvaginal delivery of specimens. Total operative time was 245min with no complications. Closure of the colpotomy was achieved laparoscopically. Post-operative course was unremarkable. Patient has done well clinically at 18 months follow-up except for an episode of post-coital spotting, which resolved spontaneously. DISCUSSION We explored the technical feasibility of concurrent laparoscopic splenectomy and hysterectomy along with transvaginal retrieval of both solid organs without morcellation. We wanted to illustrate the fact that transvaginal organ extraction may be performed safely in a community or district hospital with standard instruments without incurring additional cost, morbidity or increased operating time. CONCLUSION Transvaginal specimen retrieval was technically easy to accomplish. Our patient has not experienced any infectious complications or sexual dysfunction to date. For surgeons exploring an alternative to transabdominal specimen retrieval, transvaginal NOSE is an attractive proposition with several advantages. When combined with a gynecological procedure that involves a colpotomy, this may present a unique opportunity to explore the utility of NOSE.
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Affiliation(s)
- Mohan Ramalingam
- 18250N 32nd Street, Unit 1034, Phoenix, AZ 85032, United States.
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Transvaginal specimen removal after laparoscopic distal pancreatic resection. Langenbecks Arch Surg 2013; 398:1001-5. [PMID: 23760755 DOI: 10.1007/s00423-013-1092-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2013] [Accepted: 05/30/2013] [Indexed: 01/27/2023]
Abstract
PURPOSE Transvaginal specimen removal has been introduced 20 years ago but then abandoned. With the advent of transvaginal interventions following the introduction of natural orifice transluminal endoscopic surgery, renewed interest was generated for hybrid procedures with minimal access for the intervention and use of transvaginal (TV) specimen removal. We present the first such series after laparoscopic distal pancreatectomy. METHODS In seven subsequent women (median age 48 years) with body and tail pancreatic tumors undergoing laparoscopic distal pancreatectomy, the new method of TV specimen removal was applied. The patients' data and the technical successes as well as intra- and postprocedural complications were recorded prospectively. The patients were followed after discharge for gynecological examination. RESULTS Specimen removal consisting of the pancreas and spleen in five and the pancreas only in two cases was technically successful; no intraoperative complications were encountered. Postoperative complications consisted of one case of intra-abdominal hemorrhage and one case of pancreatic fistula, attributable to the resection and not to TV specimen removal. Gynecological follow-up was normal in all seven patients. CONCLUSIONS The technique of TV specimen removal is feasible and safe also after laparoscopic distal pancreatectomy. It may help to further diminish the access trauma of laparoscopic pancreatic surgery.
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Is the transvaginal route appropriate for intra-abdominal NOTES procedures? Experience and follow-up of 222 cases. Surg Endosc 2013; 27:2807-12. [PMID: 23392983 DOI: 10.1007/s00464-013-2812-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2012] [Accepted: 12/31/2012] [Indexed: 12/17/2022]
Abstract
BACKGROUND Since 2007, natural orifice transluminal endoscopic surgery (NOTES) has been applied in humans. We performed this prospective study to evaluate the transvaginal route in terms of risks, complication rate, and long-term side effects such as dyspareunia. METHODS From June 2007 to September 2011, we performed 222 transvaginal hybrid NOTES procedures: 220 transvaginal cholecystectomies (TVC) and 2 transvaginal appendectomies (TVA). All patients were asked to present to our associated gynecologists within 1 week for an examination. After at least 3 months, the patients were interviewed using a standard questionnaire. RESULTS All operations could be successfully performed in this technique except two cases, which were converted to conventional laparoscopic cholecystectomy. The only intraoperative complication was the puncture of the urine bladder. We observed two postoperative complications: one biliary fistula 3 days after TVC, and one abscess in the Douglas pouch 3 weeks after TVC. The gynecological examinations revealed no abnormalities. The interview (median postoperative time, 6 months) with a follow-up rate of 93 % revealed no pain in the pelvis, dyspareunia, or sexual dysfunction after TVC. CONCLUSIONS The transvaginal route is appropriate for NOTES procedures; there is only a minor and acceptable rate of intra- and postoperative morbidity.
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Recent progress in laparoscopic liver resection. Clin J Gastroenterol 2013; 6:8-15. [DOI: 10.1007/s12328-012-0352-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2012] [Accepted: 12/18/2012] [Indexed: 02/07/2023]
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Ramia JM, De La Plaza R, Quiñones JE, Veguillas P, García-Parreño J. [Minor liver resections and fenestrations using three-trocar laparoscopy]. Cir Esp 2012; 90:670-672. [PMID: 22029929 DOI: 10.1016/j.ciresp.2011.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2011] [Revised: 05/23/2011] [Accepted: 06/04/2011] [Indexed: 02/07/2023]
Affiliation(s)
- Jose M Ramia
- Unidad de Cirugía Hepatobiliopancreática, Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario de Guadalajara, España.
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Brescia A, Masoni L, Gasparrini M, Nigri G, Cosenza UM, Dall'Oglio A, Pancaldi A, Mari FS. Laparoscopic assisted transvaginal cholecystectomy: single centre preliminary experience. Surgeon 2012. [PMID: 23182808 DOI: 10.1016/j.surge.2012.09.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Natural Orifice Transluminal Endoscopic Surgery (NOTES) is a new approach that allows abdominal surgery to be performed through a natural orifice such as the oral cavity, vagina or rectum. We present our preliminary experience of laparoscopic assisted transvaginal cholecystectomy (LATC). METHODS Women affected by cholelithiasis, age below 65 years, BMI under 30, ASA I or II, previous full-term pregnancies, and without previous abdominal surgery underwent LATC. Patients' biographic data, operative time, intraoperative and postoperative complications were collected. RESULTS We performed 21 LATCs. Median operative time was 58 min. There were no intraoperative complications. The postoperative course was uneventful in all patients. At 1 year there were no complications and no impaired sexual activity. CONCLUSIONS The results of NOTES are promising, but currently only hybrid NOTES can be safely performed. LATC seems to guarantee better cosmetic results, less postoperative pain, faster mobilization and shorter hospitalization than laparoscopic cholecystectomy.
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Affiliation(s)
- Antonio Brescia
- Department of Medical and Surgical Sciences and Translational Medicine, St. Andrea Hospital, School of Medicine and Psychology, University Sapienza of Rome, Rome, Italy.
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Evaluation of the clinical and inflammatory responses in exclusively NOTES transvaginal cholecystectomy versus laparoscopic routes: an experimental study in swine. Surg Endosc 2012; 26:3232-44. [DOI: 10.1007/s00464-012-2329-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2011] [Accepted: 04/24/2012] [Indexed: 01/10/2023]
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Noguera JF, Cuadrado A. NOTES, MANOS, SILS and other new laparoendoscopic techniques. World J Gastrointest Endosc 2012; 4:212-7. [PMID: 22720121 PMCID: PMC3377862 DOI: 10.4253/wjge.v4.i6.212] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2011] [Revised: 05/06/2012] [Accepted: 05/27/2012] [Indexed: 02/05/2023] Open
Abstract
A new way of opening a body cavity can be a revolution in surgery. In 1980s, laparoscopy changed how surgeons had been working for years. Natural orifice translumenal endoscopic surgery (NOTES), minilaparoscopy-assisted natural orifice surgery (MANOS), single incision laparoscopic surgery (SILS) and other new techniques are the new paradigm in our way of operating in the 21st century. The development of these techniques began in the late 90s but they have not had enough impact to develop and evolve. Parallels between the first years of laparoscopy and NOTES can be made. Working for an invisible surgery, not only for cosmesis but for a less invasive surgery, is the target of NOTES, MANOS and SILS performed by surgeons and endoscopists over the last 10 years. The future flexible endoscopic platforms and the fusion between laparoscopic instruments and devices and robotic surgery will be a great advance for “scarless surgery”.
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Affiliation(s)
- José F Noguera
- José F Noguera, Angel Cuadrado, Consorcio Hospital General Universitario, Instituto de Investigación en Ciencias de la Salud, 46014 Valencia, Spain
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Noguera JF, Cuadrado A, Dolz C, Olea JM, García JC. Prospective randomized clinical trial comparing laparoscopic cholecystectomy and hybrid natural orifice transluminal endoscopic surgery (NOTES) (NCT00835250). Surg Endosc 2012; 26:3435-41. [PMID: 22648123 DOI: 10.1007/s00464-012-2359-4] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2012] [Accepted: 04/24/2012] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND STUDY AIMS Natural orifice transluminal endoscopic surgery (NOTES) is a technique still in experimental development whose safety and effectiveness call for assessment through clinical trials. In this paper we present a three-arm, noninferiority, prospective randomized clinical trial of 1 year duration comparing the vaginal and transumbilical approaches for transluminal endoscopic surgery with the conventional laparoscopic approach for elective cholecystectomy. PATIENTS AND METHODS Sixty female patients between the ages of 18 and 65 years who were eligible for elective cholecystectomy were randomized in a ratio of 1:1:1 to receive hybrid transvaginal NOTES (TV group), hybrid transumbilical NOTES (TU group) or conventional laparoscopy (CL group). The main study variable was parietal complications (wound infection, bleeding, and eventration). The analysis was by intention to treat, and losses were not replaced. RESULTS Cholecystectomy was successfully performed on 94% of the patients. One patient in the TU group was reconverted to CL owing to difficulty in maneuvering the endoscope. After a minimum follow-up period of 1 year, no differences were noted in the rate of parietal complications. Postoperative pain, length of hospital stay, and time off from work were similar in the three groups. No patient developed dyspareunia. Surgical time was longer among cases in which a flexible endoscope was used (CL, 47.04 min; TV, 64.85 min; TU, 59.80 min). CONCLUSIONS NOTES approaches using the flexible endoscope are not inferior in safety or effectiveness to conventional laparoscopy. The transumbilical approach with flexible endoscope is as effective and safe as the transvaginal approach and is a promising, single-incision approach.
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Affiliation(s)
- José F Noguera
- Instituto Universitario de Investigación en Ciencias de la Salud, Hospital Son Llàtzer, Carretera de Manacor, Km 4, 07198, Palma, Spain.
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Laparoscopic hybrid NOTES liver resection for metastatic colorectal cancer. Surg Laparosc Endosc Percutan Tech 2012; 22:e5-7. [PMID: 22318081 DOI: 10.1097/sle.0b013e31823f7596] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Abdominal wound extraction site continues to be a major source of morbidity after laparoscopic-assisted surgery. METHODS A 59-year-old African American woman with a past history of T3N2M1 colon cancer, who underwent laparoscopic sigmoid colectomy and wedge liver resection (segment IV A) followed by adjuvant chemotherapy was our subject for this study. Twelve months later, she was found to have a positron emission tomography positive liver lesion of 6.5 cm at the left lateral liver segment. A combined laparoscopic-transvaginal approach was used. Four 5-mm trocars were used. The liver parenchyma was divided using the harmonic scalpel, whereas the left hepatic vein was transected using the laparoscopic transvaginal vascular stapler. The specimen was placed in an endobag and extracted transvaginally. The specimen size was 14×8×3.5 cm and that of the lesion was 6.5×5.7×4 cm. The patient was discharged on postoperative day 2. RESULTS Operative time was 120 minutes and blood loss was minimal. The patient was discharged on postoperative day 2. No postoperative complications were found after 30 days. CONCLUSIONS Laparoscopic-assisted natural orifice transluminal endoscopic surgery results in quicker recovery, less postoperative pain, and potential wound-related complications. This technique is safe and effective with excellent aesthetic results. (Video, Supplemental Digital Content 1, http://links.lww.com/SLE/A54).
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Coomber RS, Sodergren MH, Clark J, Teare J, Yang GZ, Darzi A. Natural orifice translumenal endoscopic surgery applications in clinical practice. World J Gastrointest Endosc 2012; 4:65-74. [PMID: 22442743 PMCID: PMC3309895 DOI: 10.4253/wjge.v4.i3.65] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2011] [Revised: 01/25/2012] [Accepted: 03/02/2012] [Indexed: 02/05/2023] Open
Abstract
To review natural orifice translumenal endoscopic surgery (NOTES) applications in clinical practice and assess the evidence base for each application as reported in the literature. An electronic literature search was performed. Inclusion criteria were publications relating to NOTES applications in humans. For each type of operation the highest level of evidence available for clinical NOTES publications was evaluated. Morbidity and short-term operative outcomes were compared with gold standard published evidence where available. Finally, registered trials recruiting patients for NOTES applications were identified. Human NOTES publications with the highest level of evidence in each application are identified. There were no RCTs in the literature to date. The strongest evidence came in the form of large, multi-centre trials with 300-500 patients. The results are encouraging, comparable with gold standard techniques on morbidity and mortality. While short-term operative outcomes were also similar when compared to the gold standard techniques, other than improved cosmesis little else can definitely be concluded as a clear benefit of a NOTES procedure. The most common procedures are cholecystectomy, appendicectomy and peritoneoscopy mainly performed via transvaginal access. It is evident that morbidity appears to be higher when the transgastric route is used. The safety profile of hybrid NOTES transvaginal procedures is beginning to be confirmed as is evident from the large number of procedures presented in this review. A number of authors have presented work on pure NOTES procedures but the results are inconsistent and thus the vast majority of NOTES procedures worldwide are performed in a hybrid fashion with a variable amount of laparoscopy. This review of the clinical applications of NOTES summarises the growing evidence behind this surgical discipline and highlights NOTES procedures with an acceptable safety profile.
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Affiliation(s)
- Ross S Coomber
- Ross S Coomber, Mikael H Sodergren, James Clark, Julian Teare, Guang-Zhong Yang, Ara Darzi, Division of Surgery, Department of Surgery and Cancer, Imperial College London, St. Mary's Hospital, South Wharf Rd, Paddington, W2 1NY, United Kingdom
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Minimally invasive evaluation and treatment of colorectal liver metastases. Int J Surg Oncol 2012; 2011:686030. [PMID: 22312518 PMCID: PMC3263653 DOI: 10.1155/2011/686030] [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] [Received: 01/07/2011] [Accepted: 05/05/2011] [Indexed: 12/07/2022] Open
Abstract
Minimally invasive techniques used in the evaluation and treatment of colorectal liver metastases (CRLMs) include ultrasonography (US), computed tomography, magnetic resonance imaging, percutaneous and operative ablation therapy, standard laparoscopic techniques, robotic techniques, and experimental techniques of natural orifice endoscopic surgery. Laparoscopic techniques range from simple staging laparoscopy with or without laparoscopic intraoperative US, through intermediate techniques including simple liver resections (LRs), to advanced techniques such as major hepatectomies. Hereins, we review minimally invasive evaluation and treatment of CRLM, focusing on a comparison of open LR (OLR) and minimally invasive LR (MILR). Although there are no randomized trials comparing OLR and MILR, nonrandomized data suggest that MILR compares favorably with OLR regarding morbidity, mortality, LOS, and cost, although significant selection bias exists. The future of MILR will likely include expanding criteria for resectability of CRLM and should include both a patient registry and a formalized process for surgeon training and credentialing.
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Moreira-Pinto J, Lima E, Correia-Pinto J, Rolanda C. Natural orifice transluminal endoscopy surgery: A review. World J Gastroenterol 2011; 17:3795-801. [PMID: 21987621 PMCID: PMC3181440 DOI: 10.3748/wjg.v17.i33.3795] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2010] [Revised: 12/01/2010] [Accepted: 12/08/2010] [Indexed: 02/06/2023] Open
Abstract
Minimally invasive surgery started spreading worldwide in 1987, when the first laparoscopic cholecystectomy was performed. Meanwhile, improvement of endoscopic equipment and instruments allowed gastroenterologists to attempt more aggressive endoluminal interventions, even beyond the wall barrier. The first transgastric peritoneoscopy, in 2004, brought to light the concept of natural orifice transluminal endoscopic surgery (NOTES). The idea of incisionless surgery is attractive and has become a new goal for both surgeons and other people interested in this field of investigation. The authors present a review of all developments concerning NOTES, including animal studies and human experience.
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Pader K, Lescun TB, Freeman LJ. Standing Ovariectomy in Mares Using a Transvaginal Natural Orifice Transluminal Endoscopic Surgery (NOTES®) Approach. Vet Surg 2011; 40:987-97. [DOI: 10.1111/j.1532-950x.2011.00871.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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The transvaginal hybrid cholecystectomy: an enduring alternative to the laparoscopic cholecystectomy? Experience with 165 cases so far! Eur Surg 2011. [DOI: 10.1007/s10353-011-0011-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Auyang ED, Santos BF, Enter DH, Hungness ES, Soper NJ. Natural orifice translumenal endoscopic surgery (NOTES(®)): a technical review. Surg Endosc 2011; 25:3135-48. [PMID: 21553172 DOI: 10.1007/s00464-011-1718-x] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2010] [Accepted: 03/11/2011] [Indexed: 02/07/2023]
Abstract
INTRODUCTION The clinical NOTES literature continues to grow. This review quantifies the published human NOTES experience to date, examines instrument use in detail, and compiles available perioperative outcomes data. METHODS A PubMed search for all articles describing human NOTES cases was performed. All articles providing a technical description of procedures, excluding cases limited to diagnostic procedures, specimen extraction, fluid drainage or gynecological procedures, were reviewed. Two reviewers systematically cataloged the technical details of each procedure and performed a frequency analysis of instrument use in each type of case. Available outcomes data were also compiled. RESULTS Forty-three discrete articles were reviewed in detail, describing a total of 432 operations consisting of transvaginal (n = 355), transgastric (n = 58), transesophageal (n = 17), and transrectal (n = 2) procedures, with 90% of cases performed in hybrid fashion with laparoscopic assistance. Cholecystectomy (84% of cases) was the most common procedure. Analysis of key steps included choice of endoscope, establishment of peritoneal access, dissection, specimen extraction, and closure of the access site. Analysis of instrument use during transvaginal cholecystectomy revealed variation in the choice of endoscope and the technique for establishment of access. A majority of these procedures relied heavily on the use of rigid and transabdominal instrumentation. Closure of the vaginotomy site was found to be well standardized, performed with an open suturing technique. Similar analysis for transgastric procedures revealed consistency in the choice of flexible endoscope as well as access and closure techniques. Perioperative outcomes from NOTES procedures were reported, but the data are currently limited due to small case numbers. CONCLUSIONS NOTES is most commonly performed using a hybrid, transvaginal approach. Although some aspects of these procedures appear to be well standardized, there is still significant variability in technique. More outcomes data with standardized reporting are needed to determine the actual risks and benefits of NOTES.
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Affiliation(s)
- Edward D Auyang
- Department of Surgery, Northwestern University, Chicago, IL 60611, USA
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Abstract
INTRODUCTION The clinical NOTES literature continues to grow. This review quantifies the published human NOTES experience to date, examines instrument use in detail, and compiles available perioperative outcomes data. METHODS A PubMed search for all articles describing human NOTES cases was performed. All articles providing a technical description of procedures, excluding cases limited to diagnostic procedures, specimen extraction, fluid drainage or gynecological procedures, were reviewed. Two reviewers systematically cataloged the technical details of each procedure and performed a frequency analysis of instrument use in each type of case. Available outcomes data were also compiled. RESULTS Forty-three discrete articles were reviewed in detail, describing a total of 432 operations consisting of transvaginal (n = 355), transgastric (n = 58), transesophageal (n = 17), and transrectal (n = 2) procedures, with 90% of cases performed in hybrid fashion with laparoscopic assistance. Cholecystectomy (84% of cases) was the most common procedure. Analysis of key steps included choice of endoscope, establishment of peritoneal access, dissection, specimen extraction, and closure of the access site. Analysis of instrument use during transvaginal cholecystectomy revealed variation in the choice of endoscope and the technique for establishment of access. A majority of these procedures relied heavily on the use of rigid and transabdominal instrumentation. Closure of the vaginotomy site was found to be well standardized, performed with an open suturing technique. Similar analysis for transgastric procedures revealed consistency in the choice of flexible endoscope as well as access and closure techniques. Perioperative outcomes from NOTES procedures were reported, but the data are currently limited due to small case numbers. CONCLUSIONS NOTES is most commonly performed using a hybrid, transvaginal approach. Although some aspects of these procedures appear to be well standardized, there is still significant variability in technique. More outcomes data with standardized reporting are needed to determine the actual risks and benefits of NOTES.
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Pérez RC, González LRA, Reyes ED, Fernández JCD, Arias LER, Estrada MO. [The transvaginal approach in acute appendicitis]. Cir Esp 2011; 89:517-23. [PMID: 21514578 DOI: 10.1016/j.ciresp.2011.02.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2010] [Revised: 01/17/2011] [Accepted: 02/14/2011] [Indexed: 12/23/2022]
Abstract
INTRODUCTION The purpose of this work is to present 8 minilaparoscopic-assisted transvaginal appendectomies using rigid instruments in patients with acute appendicitis. MATERIAL AND METHODS Eight minilaparoscopic-assisted transvaginal appendectomies were performed from the 10th of August 2009 to the 30th of June 2010. The inclusion criteria were women between 18 and 65 years of age with a diagnosis of acute appendicitis. The exclusion criteria were palpable masses, appendicular abscesses, ASA III and IV; morbid obesity (BMI > 35); gynaecological infections; virgin patients and pregnant women. The surgical intervention was performed with rigid instruments. Surgical time, the need for post-operative analgesics, and post-surgical complications. RESULTS The age range varied between 18 and 42 years, with a mean of 29.6 years. The mean surgical time was 48.3 minutes (37-75). Analgesics were given to 2 patients after surgery (1 parenteral and 1 oral). Five patients were discharged before 24 hours and 3 at 48 hours. There were no post-operative complications. CONCLUSIONS Minilaparoscopic-assisted transvaginal appendectomy with rigid instruments, in selected women is a feasible and safe method, and with better aesthetic results than laparoscopic appendectomy, but future studies will be required that can demonstrate its advantages.
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Affiliation(s)
- Raúl Castro Pérez
- Servicio de Cirugía General, Hospital Provincial Docente Abel Santamaría Cuadrado, Ciudad de Pinar del Río, Provincia de Pinar del Río, Cuba.
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Zornig C, Siemssen L, Emmermann A, Alm M, von Waldenfels HA, Felixmüller C, Mofid H. NOTES cholecystectomy: matched-pair analysis comparing the transvaginal hybrid and conventional laparoscopic techniques in a series of 216 patients. Surg Endosc 2010; 25:1822-6. [PMID: 21181204 DOI: 10.1007/s00464-010-1473-4] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2010] [Accepted: 11/11/2010] [Indexed: 12/18/2022]
Abstract
BACKGROUND Natural orifice transluminal endoscopic surgery (NOTES) is currently a very important topic for both gastroenterologists and surgeons. We have developed a technique of transvaginal hybrid NOTES cholecystectomy (TVC) that leaves no visible scar and is applicable to daily use. This technique is compared to the conventional laparoscopic cholecystectomy (CLC) in a matched-pair analysis. METHODS From June 2007 until February 2009, 108 NOTES cholecystectomies were performed. For a matched-pair analysis we first selected a group of 192 female patients who had undergone CLC and who were operated on by the same group of surgeons in the same time period. Then 108 pairs who had TVC were matched according to the degree of inflammation of the gallbladder and age. We were able to contact 208 patients at least 3 months after surgery. Hence, the study analysis was performed with 100 complete pairs. RESULTS All 200 cholecystectomies were performed successfully without conversion. The TVC procedure was significantly longer than CLC (52 vs. 35 min, p<0.001). There were no intraoperative complications in either group. There were no significant differences with respect to reoperations, wound infections, consumption of analgesic drugs, length of hospital stay, and sick leave. Seventy-five TVC and 73 CLC patients had sexual intercourse after the operation without any complaints. CONCLUSION We present here the largest series of NOTES for cholecystectomy published to date and the first comparative study with the gold standard. The TVC technique is as successful as the CLC, it causes no more complications than CLC, especially with respect to the vaginal approach, it is more time-consuming to perform, but has an ideal cosmetic result, i.e., no visible scar.
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Affiliation(s)
- Carsten Zornig
- Department of Surgery, Israelitisches Krankenhaus, Orchideenstieg 14, 22297, Hamburg, Germany,
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Abstract
NOTES ("natural orifice transluminal endoscopic surgery") has the potential to optimize minimally invasive surgery. In gynecology there is extensive experience with the transvaginal approach to the abdominal cavity. It is easy to perform, closure is safe and there is little risk of infection. Hence, this is the approach most suitable for NOTES. By means of rigid laparoscopic instruments cholecystectomy can be routinely performed. Such operations could be performed in 149 patients in our hospital and the NOTES register of the DGAV has data on more than 900 transvaginal operations.
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Noguera Aguilar JF, Moreno Sanz C, Cuadrado García A, Olea Martínez-Mediero JM, Morales Soriano R, Vicens Arbona JC, Herrero Bogajo ML, Lozano Salvá L. [NOTES. History and current situation of natural orifice transluminal endoscopic surgery in Spain]. Cir Esp 2010; 88:222-7. [PMID: 20667526 DOI: 10.1016/j.ciresp.2010.03.046] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2009] [Revised: 03/15/2010] [Accepted: 03/16/2010] [Indexed: 12/21/2022]
Abstract
Natural orifice transluminal endoscopic surgery (NOTES), involves a group of new endoscopic approaches to the abdominal cavity, with potential advantages over conventional laparoscopic surgery. It is based on the possibility of performing intra-peritoneal surgical techniques through natural orifices by entering the peritoneal cavity through natural orifices perforating the organ that allows direct access to that cavity (stomach, vagina, rectum, bladder). The possibility of using this same route to access the retroperitoneum and mediastinum has subsequently been postulated. Comments are made on how the technique has been developed, as well as how it has been applied in our country, attempting to give a general view on the risks and benefits of NOTES and the basic requirements to be able to start in this new surgery.
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Targarona EM, Maldonado EM, Marzol JA, Marinello F. Natural orifice transluminal endoscopic surgery: The transvaginal route moving forward from cholecystectomy. World J Gastrointest Surg 2010; 2:179-86. [PMID: 21160871 PMCID: PMC2999235 DOI: 10.4240/wjgs.v2.i6.179] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2009] [Revised: 02/01/2010] [Accepted: 02/08/2010] [Indexed: 02/06/2023] Open
Abstract
The advent of minimally invasive surgery and the advances in endoluminal flexible endoscopy have converged to generate a new concept in digestive surgery, whose acronym natural orifice transluminal endoscopic surgery (NOTES), has become a familiar term in the surgical community. NOTES has been performed through the mouth, the bladder, the rectum and the vagina. Of these four approaches, the vagina has gained most popularity for several reasons. It is not only readily accessible and easy to decontaminate but it also provides safe entry and simple closure. The transvaginal approach has been described in the experimental and the clinical setting as an option for cholecystectomy, nephrectomy, splenectomy, segmental gastrectomy, retroperitoneal exploration and bariatric surgery. However, larger series are needed to delineate the exact risks of this approach, and to transcend cultural barriers that impede its wider introduction. Prospective randomized trials will shed light on the definitive role of the vaginal approach in minimal invasive surgery of the future.
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Affiliation(s)
- Eduardo M Targarona
- Eduardo M Targarona, Edgar Mauricio Maldonado, Jose Antonio Marzol, Franco Marinello, Department of Surgery, Hospital Santpau, Autonomous University of Barcelona, Sant Quinti 89, 08041 Barcelona, Spain
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Federlein M, Borchert D, Müller V, Atas Y, Fritze F, Burghardt J, Elling D, Gellert K. Transvaginal video-assisted cholecystectomy in clinical practice. Surg Endosc 2010; 24:2444-52. [PMID: 20333406 DOI: 10.1007/s00464-010-0983-4] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2009] [Accepted: 01/26/2010] [Indexed: 12/22/2022]
Abstract
BACKGROUND Transvaginal video-assisted cholecystectomy with rigid instruments is a new procedure that combines natural orifice surgery (NOS) with classic laparoscopy. This hybrid technique requires conventional laparoscopy via an umbilical incision. To date it is unclear if this procedure is safe and feasible in routine practice. METHODS We report on a case series of 128 women who consented to transvaginal cholecystectomy. Data, including visual analog scores (VAS), were collected prospectively via a standard digital spreadsheet. Patients completed satisfaction questionnaires within 10 days after discharge from hospital. We report on outcomes, age, body mass index, operating time, complications, pain scores, and patient satisfaction. RESULTS In 115 (89.8%) patients the procedure was performed as a transvaginal operation. In 11 women (8.6%), we converted to standard laparoscopy, and in 2 cases (1.6%), we converted to an open procedure. Mean age was 52.4 years (range = 23-78 years) and mean body mass index was 27.8 (range = 18.8-42). Mean operating time was 60.6 min (range = 22-110 min). Other procedures were combined with hybrid cholecystectomy in six cases. Complications following transvaginal access included one vaginal bleeding, one perforation of the urinary bladder, and one superficial lesion of the rectum. In one case the hepatic duct had to be stented due to leakage after the procedure via endoscopic retrograde cholangiography. Mean VAS on day 1 was 2.26 (± 0.31 SEM) and on day 2 it was 1.53 (± 0.35 SEM). In a postoperative questionnaire, 95% of patients indicated that they would recommend this procedure to other patients. CONCLUSIONS Transvaginal cholecystectomy is a safe and easy-to-learn procedure. Possible complications are different than those of standard laparoscopic procedures. Trauma to the abdominal wall and scarring is minimal. Postoperative pain scores were not different than those of standard laparoscopy and a high percentage of patients are satisfied with the procedure.
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Affiliation(s)
- Matthias Federlein
- Department of General and Visceral Surgery, Sana Hospital, Fanningerstr. 32, 10365, Berlin, Germany.
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Abstract
BACKGROUND The issue under debate is whether laparoscopic liver resections for malignant tumours produce outcomes which are comparable with conventional, open liver resections. METHODS Literature review on liver resection and laparoscopy. RESULTS There are no randomized controlled trials (RCTs) published that provide any evidence for the benefits of laparoscopic liver resections for liver tumours. In case-control series reporting short-term outcomes, laparoscopic liver resection has been shown to have the advantage of a reduced length of hospital stay. There are as yet, however, no adequate long-term survival studies demonstrating that laparoscopic liver resection is oncologically equivalent to open resection. DISCUSSION The challenge for the near future is to test the oncological integrity of laparoscopic liver resection in controlled trials in the same way that we have learned from the RCTs carried out in laparoscopic resection for colorectal cancer. It is likely that laparoscopic liver resection will then have to compete with fast-track, open liver resection. Already, concerns have been raised regarding the learning curve required to master the techniques of laparoscopic liver resection.
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Affiliation(s)
- Thomas van Gulik
- Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands.
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Horváth S, Gál I, Rákóczi I, Jávor S, Balatonyi B, Takács I, Ferencz A, Ferencz S, Wéber G. [Transvaginal cholecystectomy in animal model: first series in Hungary]. Magy Seb 2009; 62:120-124. [PMID: 19525177 DOI: 10.1556/maseb.62.2009.3.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
INTRODUCTION The Natural Orifice Transluminal Endoscopic Surgery (NOTES) is the newest trend in minimally invasive surgery. Based on clinical experiences, transvaginal cholecystectomy causes less pain and operative stress, requires shorter hospitalization and allows patients to return quicker to normal activity. MATERIALS AND METHODS A transvaginal cholecystectomy was carried out using hybrid technique in animal model first time in Hungary. A 5 mm umbilical trocar was used for preparation of cystic artery and duct, clip application and gallbladder dissection. A transvaginally inserted 10 mm trocar was used for laparoscopic camera to follow the procedure. Gallbladder was fixed and secured with a special curved instrument inserted also transvaginally during the procedure. At the end of procedure the gallbladder was removed transvaginally. RESULTS Six transvaginal cholecystectomies was performed on pigs. The mean time of operations was 78 min (40-145 minutes). During the operations and the follow up period (3 months) no complications and mortality was detected. CONCLUSIONS According to our experiences both procedures can be safely carried out on animal model, but further refinement of devices is necessary.
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Affiliation(s)
- Szabolcs Horváth
- Pécsi Tudományegyetem, Altalános Orvostudományi Kar, Sebészeti Oktató és Kutató Intézet 7624 Pécs Kodály Zoltán u. 20.
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Sánchez-Margallo FM, Asencio Pascual JM, Del Carmen Tejonero Alvarez M, Sánchez Hurtado MA, Pérez Duarte FJ, Usón Gargallo J, Sánchez-Gijón SP. [Training design and improvement of technical skills in the transvaginal cholecystectomy (NOTES)]. Cir Esp 2009; 85:307-13. [PMID: 19376505 DOI: 10.1016/j.ciresp.2009.02.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2008] [Accepted: 02/17/2009] [Indexed: 01/15/2023]
Abstract
INTRODUCTION The current surgical scenario of the surgery through natural orifices or <<no-scar surgery>> requires acquiring new technical skills by the surgeon. We introduce the initial experience of the Minimally Invasive Surgery Centre Jesús Usón (MISCJU) in the design and setting-up of a surgical training programme using the the natural orifices approach for the acquisition of surgical skills and abilities, based on the preliminary trials in simulators and a pig model. MATERIAL AND METHODS After initial training, using a laparoscopic pelvic-trainer, 7 female pigs, with weights between 35-40 kg, were operated on. The transvaginal approach was completed using a one-channel gastroscope in all the animals. After accessing the abdomen, the abdominal cavity was explored, and the surgery was concluded with the endoscopic cholecystectomy. RESULTS Endoscopic cholecystectomy was successfully completed in 6 cases. In one of the animals, the procedure was stopped because of technical problems regarding the endoscope leaning to one end. The average surgical time was 107.14 min (range, 80-150 min). The transvaginal approach enabled the abdominal to be explored and the dissection, ligature and section of the cystic duct and the cystic artery. After cholecystectomy, the gallbladder was extracted through the vagina. After the procedure necropsy did not reveal intra-abdominal lesions or intraoperative complications. CONCLUSIONS The pure transvaginal cholecystectomy is a feasible and reproducible procedure in the animal model. A systematized training model, which includes physiopathology knowledge as well as technical knowledge, in order to translate these procedures to the clinical practice in a safe way, is needed.
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Transintestinal hepatectomy performed by hybrid NOTES using a customized X-TRACT Tissue Morcellator with an electrifiable round cutter. ACTA ACUST UNITED AC 2009; 16:274-82. [PMID: 19363585 DOI: 10.1007/s00534-009-0084-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2009] [Accepted: 02/27/2009] [Indexed: 12/18/2022]
Abstract
BACKGROUND/PURPOSE We tried to determine whether the customization of an X-TRACT Tissue Morcellator could avoid the laceration-induced distension of surgical incisions/openings when transintestinally removing resected liver tissue from the body, when the greatest dimension of the tissue exceeded the dimension of the opening. METHODS Pigs were used to examine changes in the caliber and shape of surgical incisions made with a conventional hook knife and insulation-tipped diathermic (IT) knife for electrodissection in endoscopy, and to examine changes in circular incision made with a customized X-TRACT Tissue Morcellator. The ENDO CATCH II device was used to remove tissue. RESULTS Laceration occurred in the "roundness-lost portion" of the surgical incisions made with the hook knife, thus confirming the greatest dimension of the distended incisions and the occurrence of an irregular laceration. In the circular incision that were made with the customized X-TRACT Tissue Morcellator, by contrast, the removal of resected liver tissue whose greatest dimension was fivefold greater than that of the surgical openings did not increase the caliber of the openings. The shape of the openings remained round, and no laceration was observed. CONCLUSIONS The use of the customized X-TRACT Tissue Morcellator with an electrifiable round cutter allowed the performance of transintestinal hepatectomy and the removal of a solid organ through surgical openings that had been made in the gastrointestinal wall.
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