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Brand M, Fuchs KH, Troya J, Hann A, Meining A. The Role of Specialized Instruments for Advanced Endoscopic Resections in Gastrointestinal Disease. Life (Basel) 2023; 13:2177. [PMID: 38004317 PMCID: PMC10672436 DOI: 10.3390/life13112177] [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: 08/04/2023] [Revised: 09/13/2023] [Accepted: 10/04/2023] [Indexed: 11/26/2023] Open
Abstract
INTRODUCTION Advanced endoscopic therapy techniques have been developed and have created alternative treatment options to surgical therapy for several gastrointestinal diseases. This work will focus on new endoscopic tools for special indications of advanced endoscopic resections (ER), especially endoscopic submucosal dissection (ESD), which were developed in our institution. This paper aims to analyze these specialized instruments and identify their status. METHODS Initially, the technical process of ESD was analyzed, and the following limitations of the different endoscopic steps and the necessary manipulations were determined: the problem of traction-countertraction, the grasping force needed to pull on tissue, the instrument tip maneuverability, the limited angulation/triangulation, and the mobility of the scope and instruments. Five instruments developed by our team were used: the Endo-dissector, additional working channel system, external independent next-to-the-scope grasper, 3D overtube working station, and over-the-scope grasper. The instruments were used and applied according to their special functions in dry lab, experimental in vivo, and clinical conditions by the members of our team. RESULTS The Endo-dissector has a two-fold function: (1) grasping submucosal tissue with enough precision and strength to pull it off the surrounding mucosa and muscle, avoiding damage during energy application and (2) effectively dividing tissue using monopolar energy. The AWC system quickly fulfills the lack of a second working channel as needed to complete the endoscopic task on demand. The EINTS grasper can deliver a serious grasping force, which may be necessary for a traction-countertraction situation during endoscopic resection for lifting a larger specimen. The 3D overtube multifunctional platform provides surgical-like work with bimanual-operated instruments at the tip of the scope, which allows for a coordinated approach during lesion treatment. The OTSG is a grasping tool with very special features for cleaning cavities with debris. CONCLUSIONS The research and development of instruments with special features can solve unmet needs in advanced endoscopic procedures. The latter may help to increase indications for the endoscopic resections of gut lesions in the future.
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Affiliation(s)
| | - Karl-Hermann Fuchs
- Interventional and Experimental Endoscopy (InExEn), Department of Internal Medicine II, Gastroenterology, University of Würzburg, 97070 Würzburg, Germany; (M.B.); (J.T.); (A.M.)
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Fu T, Ren J, Yao H, Huang B, Sun L, Li X, Tong W. Feasibility and safety of hybrid transvaginal natural orifice transluminal endoscopic surgery for colon cancer: Protocol for a multicenter, single-arm, phase II trial (vNOTESCA). Heliyon 2023; 9:e20187. [PMID: 37780770 PMCID: PMC10539939 DOI: 10.1016/j.heliyon.2023.e20187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 09/04/2023] [Accepted: 09/13/2023] [Indexed: 10/03/2023] Open
Abstract
INTRODUCTION It has been a decade since the first patient with colon cancer underwent colectomy by hybrid transvaginal natural orifice transluminal endoscopic surgery (hvNOTES). However, the efficacy and safety of this procedure is not well established. METHODS This study is an open-label, multicenter, single-arm, phase 2 trial undertaken at six centers in China. Female patients aged over 18 years and below 80 years old with an Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1, with pathologically proven, resectable, cT1-3N0-2M0 disease who have previously untreated colon cancer are eligible for inclusion. The primary endpoint is a composite of major intraoperative and postoperative complications (greater than grade III, the Common Terminology Criteria for Adverse Events [CTCAE], version 5.0). Secondary endpoints include conversion to laparoscopic or open surgery, postoperative concentration of C-Reactive Protein and procalcitonine, complete pathological assessment of complete mesocolic excision specimens, postoperative pain, amount of narcotic pain medication administered, time to first flatus after surgery, number of harvested lymph nodes, R0 resection rate, length of hospital stay, sexual function assessment, quality of recovery, satisfaction with surgical scars, quality of life, postoperative recurrence patterns, relapse-free survival, and overall survival. ETHICS AND DISSEMINATION The study was approved by the Research Ethics Committee, Renmin Hospital of Wuhan University, China, number: WDRY2022-K053. All patients will receive written information of the trial and provide informed consent before enrollment. The results of this trial will be disseminated in academic conferences and peer-reviewed medical journals.Trial registration number NCT04048421.
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Affiliation(s)
- Tao Fu
- Department of General Surgery, Qingdao Hospital, University of Health and Rehabilitation Sciences, Qingdao Municipal Hospital, China
- Department of Gastrointestinal Surgery II, Renmin Hospital of Wuhan University, China
| | - Jun Ren
- Department of Gastrointestinal Surgery II, Renmin Hospital of Wuhan University, China
| | - Hongwei Yao
- Department of Colorectal Surgery, Beijing Friendship Hospital of Capital Medical University, China
| | - Bin Huang
- Department of Gastrointestinal Surgery, Daping Hospital of Army Medical University, China
| | - Lifeng Sun
- Department of Colorectal Surgery, The Second Affiliated Hospital of Zhejiang University, China
| | - Xiaorong Li
- Department of Colorectal Surgery, The Third Xiangya Hospital of Central South University, China
| | - Weidong Tong
- Department of Gastrointestinal Surgery, Daping Hospital of Army Medical University, China
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Zeng Y, Yang J, Zhang JW. Endoscopic transluminal drainage and necrosectomy for infected necrotizing pancreatitis: Progress and challenges. World J Clin Cases 2023; 11:1888-1902. [PMID: 36998953 PMCID: PMC10044952 DOI: 10.12998/wjcc.v11.i9.1888] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 02/06/2023] [Accepted: 03/01/2023] [Indexed: 03/16/2023] Open
Abstract
Infected necrotizing pancreatitis (INP) represents a severe condition in patients with acute pancreatitis. Invasive interventions are recommended in symptomatic INP. Growing evidence has suggested interventional strategies of INP evolving from traditional surgery to minimally invasive step-up endoscopic procedures. However, there is still no standardized protocol for endoscopic interventions. Recently, various studies have been published about the endoscopic management of INP. This article reviews published articles and guidelines to present the progress and challenges of endoscopic transluminal drainage and necrosectomy in INP.
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Affiliation(s)
- Yan Zeng
- Department of Psychology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China
| | - Jian Yang
- Department of Gastroenterology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Jun-Wen Zhang
- Department of Gastroenterology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
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Progress in Control-Actuation Robotic System for Gastrointestinal NOTES Development. BIOMED RESEARCH INTERNATIONAL 2022; 2022:7047481. [PMID: 36349314 PMCID: PMC9637469 DOI: 10.1155/2022/7047481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 09/19/2022] [Accepted: 10/10/2022] [Indexed: 11/17/2022]
Abstract
Purpose Natural orifice transluminal endoscopic surgery (NOTES) is a minimally invasive surgical procedure that reduces patient trauma, infection probability, and rehabilitation time. This paper reviews the progress made in the control-actuation robotic systems for gastrointestinal NOTES development. Material and Methods. A survey on both existing and state-of-the-art control-actuation robotic systems for gastrointestinal NOTES was conducted in December 2021. Results Nine control-actuation robotic systems for gastrointestinal NOTES were identified. The structures and specifications of these robotic systems were reported. The technical parameters were also discussed. Special attention was directed to systems using a control-actuation structure and tendon-driven mechanism. The control-actuation robotic systems typically deploy a control-actuation structure and tendon-driven mechanism. Control-actuation robotic systems for gastrointestinal NOTES show great ability to improve operational accuracy and flexibility and flatten the learning curve of procedures. These characteristics suggest that the use of control-actuation robotic systems is worth exploring in future development.
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Saini S, Orlando MF, Pathak PM. Intelligent Control of a Master-Slave based Robotic Surgical System. J INTELL ROBOT SYST 2022. [DOI: 10.1007/s10846-022-01684-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Precise Control and Experimental Evaluation of a Novel Endoscopic Suturing Device for Large Perforations. J Med Biol Eng 2021. [DOI: 10.1007/s40846-021-00619-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Chan KL, Yeung CK, Lam KW, Cheung JLK, Sreedhar B, Ngan HY. Robotic Natural Orifice Transluminal Endoscopic Surgery Hysterectomy and Salpingo-Oophorectomy in a Porcine Model. Surg Innov 2021; 29:215-224. [PMID: 33980081 DOI: 10.1177/15533506211018433] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose. The emergence of robotic-assisted surgical techniques has gained significant indications in terms of reduced trauma, shortened recovery, and higher patients' satisfaction. However, limitations by present surgical robotic systems used in natural orifice transluminal endoscopic surgery (NOTES) gynecology still exists, such as arm collisions, countertraction, instrument dexterity, and, in particular, space confinement due to the narrow pelvic anatomy. The current study evaluated the use of a miniaturized single-site surgical robotic system and its feasibility in performing robotic NOTES gynecological procedures using a live porcine animal model. Methods. Using a transrectal approach, the fully internalized robotic arms were deployed in a reverse configuration to access the lower pelvic cavity of the animals to perform NOTES gynecological procedures. Results. Robotic-assisted transrectal gynecological procedures were successfully performed using the new robotic system. A hemi-hysterectomy with unilateral salpingo-oophorectomy was completed in the first animal and a total hysterectomy with bilateral salpingo-oophorectomy in the second animal with an average docking time of 22.5 minutes and console time of 63 minutes and 58 minutes, respectively. The overall blood loss for each procedure was estimated to be <20 mL per animal with no intraoperative complications. Conclusions. The reverse configuration of the miniaturized surgical robotic system has demonstrated its capability to provide a potential solution to maintain clear visualization of the surgical field, optimal triangulation, and dexterity robotic NOTES gynecological procedures within the deep confined space of the pelvic cavity.
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Affiliation(s)
- KarenKar-Loen Chan
- Li Ka Shing Faculty of Medicine, Department of Obstetrics & Gynaecology, 25809The University of Hong Kong, Hong Kong, Hong Kong
| | - Chung-Kwong Yeung
- Department of Surgery, Li Ka Shing Faculty of Medicine, 25809The University of Hong Kong, Hong Kong, Hong Kong.,Bio-Medical Engineering (HK) Limited, Hong Kong, Hong Kong
| | - Kwok-Wai Lam
- Bio-Medical Engineering (HK) Limited, Hong Kong, Hong Kong.,Li Ka Shing Faculty of Medicine, Department of Orthopaedics and Traumatology, 25809The University of Hong Kong, Hong Kong, Hong Kong
| | | | - Biji Sreedhar
- Bio-Medical Engineering (HK) Limited, Hong Kong, Hong Kong
| | - Hextan Ys Ngan
- Li Ka Shing Faculty of Medicine, Department of Obstetrics & Gynaecology, 25809The University of Hong Kong, Hong Kong, Hong Kong
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Abstract
Geriatric patients tend to have subtle presentations of biliary disorders and, if untreated, can decompensate acutely. Each biliary disorder warrants formulation of an individualized treatment plan with a multidisciplinary approach. Acute cholecystitis, a common complication of gallstones, is initially managed by conservative measures and subsequently, among patients with optimal surgical risk, through laparoscopic or open cholecystectomy. High-risk patients undergo temporization, percutaneous or endoscopic, followed by definitive intervention. Acute cholecystitis with complications (ie, perforation, gangrene, or small bowel obstruction) warrants emergent cholecystectomy. Gallstone migration into the biliary system can cause choledocholithiasis, often complicated by biliary pancreatitis or cholangitis if not intervened. Therapy for choledocholithiasis is based on biliary clearance through endoscopic and, infrequently, surgical approaches.
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Bu J, Li N, He S, Deng HY, Wen J, Yuan HJ, Zhang CM, Hu M, Wu XT. Effect of laparoscopic surgery for colorectal cancer with N. O. S. E. on recovery and prognosis of patients. MINIM INVASIV THER 2020; 31:230-237. [PMID: 32940092 DOI: 10.1080/13645706.2020.1799410] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To investigate the effect of laparoscopic surgery in colorectal cancer (CRC) patients with natural orifice specimen extraction (NOSE) on the recovery and quality of life (QOL) of patients. MATERIAL AND METHODS Ninety-two eligible patients were randomly assigned into two groups: the traditional laparoscopy group (L group, n = 46) and the laparoscopic transanal specimen extraction group (NL group, n = 46). General data, surgery-related indicators, postoperative recovery, and prognosis were compared and analyzed between the two groups. RESULTS A total of 46 patients in each group were enrolled in this study. The general data and surgery-related indicators were comparable between the two groups (all p > .05). There were no significant differences in the time of first flatus, bleeding, obstruction, constipation, and infectious complications between the two groups (all p > .05). The differences in the incidence of postoperative diarrhea, pain degree, and satisfaction on the aesthetics of the abdominal wall showed significant differences (χ2 = 6.133, p = .013; χ2 = 12.116, p = .017; χ2 = 13.463, p = .004). The postoperative follow-up time was 3-53 months. There were no significant differences in the postoperative hospital stay, medical costs, hospital readmission rate, incidence of incisional hernia, overall survival, disease-free survival, and QOL between the two groups (all p > .05). Conclusion: Laparoscopic surgery with NOSE for eligible patients with CRC was a feasible choice.
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Affiliation(s)
- Jun Bu
- Department of General Surgery, Chengdu second people's Hospital, Chengdu, China
| | - Nian Li
- Department of General Surgery, Chengdu second people's Hospital, Chengdu, China
| | - Shan He
- Department of General Surgery, Chengdu second people's Hospital, Chengdu, China
| | - Heng-Yi Deng
- Department of General Surgery, Chengdu second people's Hospital, Chengdu, China
| | - Jing Wen
- Department of General Surgery, Chengdu second people's Hospital, Chengdu, China
| | - Hong-Jun Yuan
- Department of General Surgery, Chengdu second people's Hospital, Chengdu, China
| | - Chuan-Ming Zhang
- Department of Digestive Medicine, Chengdu second people's Hospital, Chengdu, China
| | - Man Hu
- Department of Digestive Medicine, Chengdu second people's Hospital, Chengdu, China
| | - Xiao-Ting Wu
- Department of Gastrointestinal Surgery Center, West China Hospital, Sichuan University, Chengdu, China
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Lee DH, Cheon B, Kim J, Kwon DS. easyEndo robotic endoscopy system: Development and usability test in a randomized controlled trial with novices and physicians. Int J Med Robot 2020; 17:1-14. [PMID: 32875670 DOI: 10.1002/rcs.2158] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 08/27/2020] [Accepted: 08/28/2020] [Indexed: 01/14/2023]
Abstract
BACKGROUND Some difficulties are common when using endoscopes. Steering is not intuitive, the endoscope weight is a physical burden to physicians and communication problems often occur between operators. METHOD To overcome these, we developed a robotic endoscopy system and conducted a usability test to compare conventional and robotic manipulation. Nine novices and eighteen physicians participated with the physicians being divided into intermediate and expert groups. The participants performed endoscope insertion into a simulator (physicians) or lesion marking on a testbed (novices) and simulate biopsies. RESULT Novices completed the tasks faster and with a lower workload when using robotic manipulation, whereas the experts showed the opposite trend. Still, the intermediates showed no significant difference as trials proceeded. Nevertheless, the learning curve analysis showed that the learning rate in all groups is greater for robotic manipulation (21.02% on average) than for conventional manipulation (13.75%) and predicted that physicians can reach manual performance. CONCLUSION The proposed robotic endoscopy system may allow solo-manipulation using one controller and may be more intuitive and convenient to use than conventional manipulation.
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Affiliation(s)
- Dong-Ho Lee
- The Robotics Program, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, Republic of Korea
| | - Byungsik Cheon
- The Robotics Program, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, Republic of Korea.,EasyEndo Surgical Inc., Daejeon, Republic of Korea
| | - Joonhwan Kim
- Department of Mechanical Engineering, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, Republic of Korea
| | - Dong-Soo Kwon
- The Robotics Program, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, Republic of Korea.,EasyEndo Surgical Inc., Daejeon, Republic of Korea.,Department of Mechanical Engineering, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, Republic of Korea
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Hwang M, Kwon D. K‐FLEX: A flexible robotic platform for scar‐free endoscopic surgery. Int J Med Robot 2020; 16:e2078. [DOI: 10.1002/rcs.2078] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Revised: 12/30/2019] [Accepted: 01/09/2020] [Indexed: 12/17/2022]
Affiliation(s)
- Minho Hwang
- Department of Mechanical EngineeringKorea Advanced Institute of Science and Technology (KAIST) Daejeon Republic of Korea
| | - Dong‐Soo Kwon
- Department of Mechanical EngineeringKorea Advanced Institute of Science and Technology (KAIST) Daejeon Republic of Korea
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Oude Vrielink TJC, Vitiello V, Mylonas GP. Robotic surgery in cancer. BIOENGINEERING INNOVATIVE SOLUTIONS FOR CANCER 2020:245-269. [DOI: 10.1016/b978-0-12-813886-1.00012-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2025]
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Fuchs KH, Schulz T, Broderick R, Breithaupt W, Babic B, Varga G, Horgan S. Transanal hybrid colon resection: techniques and outcomes for benign colorectal diseases. Surg Endosc 2019; 34:3487-3495. [PMID: 31559574 DOI: 10.1007/s00464-019-07126-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 09/17/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Transanal hybrid rectal and colon resection have been introduced in recent years at dedicated surgical centers. The anus is used as a natural orifice for large size access. The use of transanal hybrid colectomy techniques is still in its infancy with outcomes and unique complications being identified. The purpose of this work is the evaluation of outcomes for transanal hybrid colon resections (ta-CR), including intra operative and postoperative complications, results, and advantages. METHODS A prospectively maintained database was analyzed. Inclusion criteria were any patient who underwent ta-CR for rectal prolapse, slow transit, obstructive defaecation, and chronic sigmoid diverticulitis. Patients were excluded from ta-CR if BMI > 30, major previous abdominal surgery, or presence of a large inflammatory mass in diverticulitis. Transanal access was used for all operative steps requiring access of more than 5 mm, such as staplers, large graspers, and specimen retrieval. Data acquisition and analysis was performed for operative time, complications, and postoperative quality of life. RESULTS From 2012 to 2017, 82 patients underwent ta-CR [33 males, 49 females, median age 58 (24-80)]. Transanal-subtotal colectomy and ta-CR for constipation was performed in 12 patients; ta-CR and rectopexy in 31, and ta-CR for diverticulitis was performed in 39 patients. Conversion to traditional approach was required in 3 cases (3.6%). Intraoperative complication included 1 rectal tear requiring intervention. Post-op complications included 3 leaks requiring laparoscopic and 1 open revision, the latter developed wound infection and an incisional hernia. Gastrointestinal Quality of Life Index (GIQLI) improved significantly from preoperative 89 to postoperative 119 (p < 0.001). No patients with ta-CR without open revision developed a hernia post-op with median 18 months follow-up. CONCLUSIONS ta-CR is a safe and effective NOTES Hybrid technique for colorectal procedures in selected patients with benign colon disorders. GIQLI shows improvement and this technique can have the potential in preventing wound and hernia complications.
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Affiliation(s)
- Karl-Hermann Fuchs
- Department of Surgery, Center for the Future of Surgery, University of California San Diego, 9500 Gilman Drive, MC:0740, La Jolla, CA, 92093, USA.
| | - Thomas Schulz
- Department of General- and Viszeral-Surgery, AGAPLESION Markus Krankenhaus, Frankfurt am Main, Germany
| | - Ryan Broderick
- Department of Surgery, Center for the Future of Surgery, University of California San Diego, 9500 Gilman Drive, MC:0740, La Jolla, CA, 92093, USA
| | - Wolfram Breithaupt
- Department of General- and Viszeral-Surgery, AGAPLESION Markus Krankenhaus, Frankfurt am Main, Germany
| | - Benjamin Babic
- Department of Surgery, University of Mainz, Mainz, Germany
| | - Gabor Varga
- Department of General- and Viszeral-Surgery, AGAPLESION Markus Krankenhaus, Frankfurt am Main, Germany
| | - Santiago Horgan
- Department of Surgery, Center for the Future of Surgery, University of California San Diego, 9500 Gilman Drive, MC:0740, La Jolla, CA, 92093, USA
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Fu T, Liu Y, Li K. Hybrid transvaginal natural orifice transluminal endoscopic surgery of radical sigmoidectomy for sigmoid colon cancer. Surg Oncol 2019; 30:90-91. [PMID: 31500793 DOI: 10.1016/j.suronc.2019.05.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 05/04/2019] [Accepted: 05/25/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Transvaginal natural orifice transluminal endoscopic surgery (NOTES) is a surgical technique - "scarless" abdominal operations performed with a multi-channel endoscope passed through a natural orifice (mouth, urethra, anus, vagina etc.) and offers less invasive and more excellent cosmetic results [1]. It is regarded as safe and feasible in patients with benign disease [2,3]. The first case of pure NOTES for sigmoid colon cancer was reported in 2012 [4]. We describe here a case of curatively intended resection for early-stage sigmoid colon cancer using the hybrid transvaginal NOTES approach. METHODS This video demonstrates the case of a 52-year-old woman with sigmoid colon cancer treated by hybrid transvaginal NOTES. Her body mass index was 20.4 kg/m2. A laparoscope was inserted above the umbilicus and tumor's position was located. Two 5 mm trocars inserted in the right lower abdominal quadrant were mainly used for the assistant's instruments to provide traction and exposure. A single-port was inserted into the abdominal cavity transvaginally through the colpotomy. Then all the procedures were performed transvaginally with conventional rigid laparoscopic instruments. The sigmoid colon was mobilized using a lateral to medial approach. Then the root of the inferior mesenteric artery and the inferior mesenteric vein were divided with absorbable clips. After complete isolation of the proximal rectum, the rectum was transected 5 cm distal to the lesion with a linear stapler inserted through the single port. The proximal resection margin of descending colon was identified and the transection of the colon was performed. The specimen was removed transvaginally. The colon was then exteriorized and the anvil was fixed in the colon. An end-to-end anastomosis was performed using a circular stapler, and a leak test was done. RESULTS The operative time and estimated blood loss were 182 min and 50 mL. A 20 cm long segment of sigmoid colon was resected with negative tumor margins, and 16 lymph nodes were harvested. There was no intraoperative or postoperative morbidity. The patient was with out-of-bed activity on day 1, fluid diet on day 2, bowel movement on day3, and the drainage tube and catheter removing on day 4. On day 5, she was discharged. Pathological examination revealed a moderately-differentiated adenocarcinoma: 50 × 45 × 10 mm, with growing into subserosa, without vascular or nervous invasion, pT3N0M0 and pStage IIA. There were two scars less than 5 mm and one scar less than 10 mm visible on the abdominal wall at one month. The patient was alive without recurrence after one year's follow-up. CONCLUSION Hybrid transvaginal NOTES of radical sigmoidectomy may be safe and feasible for selected patients with sigmoid colon cancer and give less pain, potentially low rates of complication, faster recovery, and better cosmesis. A future large study is warranted to better evaluate this procedure. Although there are many reasons for skepticism, there is undoubted interest in this field from both surgeon and patient.
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Affiliation(s)
- Tao Fu
- Department of Gastrointestinal Surgery II, Key Laboratory of Hubei Province for Digestive System Disease, Renmin Hospital, Wuhan University, China.
| | - Yanliang Liu
- Department of Gastrointestinal Surgery II, Key Laboratory of Hubei Province for Digestive System Disease, Renmin Hospital, Wuhan University, China
| | - Kai Li
- Department of Gastrointestinal Surgery II, Key Laboratory of Hubei Province for Digestive System Disease, Renmin Hospital, Wuhan University, China
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Du B, Fan YJ, Zhao LX, Geng XY, Li DL, Wu XW, Zhang DK, Liu BR. A reliable detachable balloon that prevents abdominal cavity contamination during transrectal natural orifice transluminal endoscopic surgery. J Dig Dis 2019; 20:383-390. [PMID: 31069947 DOI: 10.1111/1751-2980.12757] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 04/20/2019] [Accepted: 05/06/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To evaluate the efficacy and safety of a detachable endoluminal balloon in the prevention of abdominal cavity contamination during transrectal natural orifice transluminal endoscopic surgery (NOTES). METHODS The efficacy and safety of a detachable endoluminal balloon to maintain disinfection in the distal colon of the pigs were evaluated. The bacterial loads and colonic cleanliness were monitored. Additionally, the device was applied to another nine pigs that underwent a cholecystotomy by transrectal NOTES. Necropsy and pathological examination were performed after 28-day follow-up. RESULTS All animals exposed to the device and one of the seven pigs not exposed to the device scored three points on the bowel cleanliness scale (P < 0.001). After 30 min bacterial loads of the test (with balloon occlusion) and control (without balloon occlusion) groups showed a significant difference (0.8 × 103 CFU/mL vs 186.8 × 103 CFU/mL, P < 0.01). Cholecystotomy by transrectal NOTES with the device was successfully performed. The mean intraperitoneal procedure time was 102.9 ± 37.7 min. There were no procedure-related adverse events. During the follow-up, all animals presented normal behavior and appetite. No peritoneal infection or adhesion was detected at autopsy. Cholecystotomy and rectal incision were histologically healed and no histological abnormalities were detected in the colon related to balloon placement. CONCLUSIONS The detachable balloon provides a reliable solution for preventing peritoneal contamination during transluminal operations. The technique may assist in future transrectal NOTES.
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Affiliation(s)
- Bing Du
- Department of Gastroenterology and Hepatology, Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China
| | - Yu Jing Fan
- Department of Gastroenterology and Hepatology, Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China
| | - Li Xia Zhao
- Department of Gastroenterology and Hepatology, Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China.,Department of Gastroenterology and Hepatology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Xin Yu Geng
- Department of Gastroenterology and Hepatology, Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China
| | - De Liang Li
- Department of Gastroenterology and Hepatology, Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China.,Department of Gastroenterology and Hepatology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Xiu Wen Wu
- Department of Gastroenterology and Hepatology, Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China
| | - De Kai Zhang
- Department of Gastroenterology and Hepatology, Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China
| | - Bing Rong Liu
- Department of Gastroenterology and Hepatology, Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China.,Department of Gastroenterology and Hepatology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
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Abstract
Transluminal surgery, also known as natural orifices endoluminal surgery, can be considered the most minimally invasive approach of gaining access to an organ. Although some approaches, such as transgastric or transvaginal cholecystectomy, have remained experimental, peroral endoscopic myotomy to treat achalasia and transanal total mesorectal excision to treat low rectal cancer have become accepted, safe, and feasible approaches by trained surgeons for selected patients. This article recapitulates the development of transluminal surgery from its experimental beginnings to the validated procedure it has become today.
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Affiliation(s)
- Antonio M Lacy
- Department of Gastrointestinal Surgery, ICMDM, IDIBAPS, CIBEREHD, AIS Channel, Hospital Clínic, Universitat de Barcelona, Villarroel 170, 08036 Barcelona, Spain.
| | - Fransisco Borja De Lacy
- Department of Gastrointestinal Surgery, ICMDM, IDIBAPS, CIBEREHD, AIS Channel, Hospital Clínic, Universitat de Barcelona, Villarroel 170, 08036 Barcelona, Spain
| | - Silvia Valverde
- Department of Gastrointestinal Surgery, ICMDM, IDIBAPS, CIBEREHD, AIS Channel, Hospital Clínic, Universitat de Barcelona, Villarroel 170, 08036 Barcelona, Spain
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Atallah S, Hodges A, Larach SW. Direct target NOTES: prospective applications for next generation robotic platforms. Tech Coloproctol 2018; 22:363-371. [PMID: 29855814 DOI: 10.1007/s10151-018-1788-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 05/04/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND A new era in surgical robotics has centered on alternative access to anatomic targets and next generation designs include flexible, single-port systems which follow circuitous rather than straight pathways. Such systems maintain a small footprint and could be utilized for specialized operations based on direct organ target natural orifice transluminal endoscopic surgery (NOTES), of which transanal total mesorectal excision (taTME) is an important derivative. METHODS During two sessions, four direct target NOTES operations were conducted on a cadaveric model using a flexible robotic system to demonstrate proof-of-concept of the application of a next generation robotic system to specific types of NOTES operations, all of which required removal of a direct target organ through natural orifice access. These four operations were (a) robotic taTME, (b) robotic transvaginal hysterectomy in conjunction with (c) robotic transvaginal salpingo-oophorectomy, and in an ex vivo model, (d) trans-cecal appendectomy. RESULTS Feasibility was demonstrated in all cases using the Flex® Robotic System with Colorectal Drive. During taTME, the platform excursion was 17 cm along a non-linear path; operative time was 57 min for the transanal portion of the dissection. Robotic transvaginal hysterectomy was successfully completed in 78 min with transvaginal extraction of the uterus, although laparoscopic assistance was required. Robotic transvaginal unilateral salpingo-oophorectomy with transvaginal extraction of the ovary and fallopian tube was performed without laparoscopic assistance in 13.5 min. In an ex vivo model, a robotic trans-cecal appendectomy was also successfully performed for the purpose of demonstrating proof-of-concept only; this was completed in 24 min. CONCLUSIONS A flexible robotic system has the potential to access anatomy along circuitous paths, making it a suitable platform for direct target NOTES. The conceptual operations posed could be considered suitable for next generation robotics once the technology is optimized, and after further preclinical validation.
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Affiliation(s)
- S Atallah
- Endo-Surgical Center of Florida, Department of Colorectal Surgery, Florida Hospital, Orlando, FL, USA.
| | - A Hodges
- Nova Southeastern University, Davie, FL, USA
| | - S W Larach
- Endo-Surgical Center of Florida, Department of Colorectal Surgery, Florida Hospital, Orlando, FL, USA
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Korzeniowski P, Barrow A, Sodergren MH, Hald N, Bello F. NOViSE: a virtual natural orifice transluminal endoscopic surgery simulator. Int J Comput Assist Radiol Surg 2016; 11:2303-2315. [PMID: 27314591 PMCID: PMC5110615 DOI: 10.1007/s11548-016-1401-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Accepted: 03/23/2016] [Indexed: 12/13/2022]
Abstract
PURPOSE Natural orifice transluminal endoscopic surgery (NOTES) is a novel technique in minimally invasive surgery whereby a flexible endoscope is inserted via a natural orifice to gain access to the abdominal cavity, leaving no external scars. This innovative use of flexible endoscopy creates many new challenges and is associated with a steep learning curve for clinicians. METHODS We developed NOViSE-the first force-feedback-enabled virtual reality simulator for NOTES training supporting a flexible endoscope. The haptic device is custom-built, and the behaviour of the virtual flexible endoscope is based on an established theoretical framework-the Cosserat theory of elastic rods. RESULTS We present the application of NOViSE to the simulation of a hybrid trans-gastric cholecystectomy procedure. Preliminary results of face, content and construct validation have previously shown that NOViSE delivers the required level of realism for training of endoscopic manipulation skills specific to NOTES. CONCLUSIONS VR simulation of NOTES procedures can contribute to surgical training and improve the educational experience without putting patients at risk, raising ethical issues or requiring expensive animal or cadaver facilities. In the context of an experimental technique, NOViSE could potentially facilitate NOTES development and contribute to its wider use by keeping practitioners up to date with this novel surgical technique. NOViSE is a first prototype, and the initial results indicate that it provides promising foundations for further development.
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Affiliation(s)
- Przemyslaw Korzeniowski
- Centre for Engagement and Simulation Science, Department of Surgery and Cancer, Imperial College London, Chelsea and Westminster Hospital, 369 Fulham Road, SW10 9NH, London, UK
| | - Alastair Barrow
- Centre for Engagement and Simulation Science, Department of Surgery and Cancer, Imperial College London, Chelsea and Westminster Hospital, 369 Fulham Road, SW10 9NH, London, UK
| | | | - Niels Hald
- Centre for Engagement and Simulation Science, Department of Surgery and Cancer, Imperial College London, Chelsea and Westminster Hospital, 369 Fulham Road, SW10 9NH, London, UK
| | - Fernando Bello
- Centre for Engagement and Simulation Science, Department of Surgery and Cancer, Imperial College London, Chelsea and Westminster Hospital, 369 Fulham Road, SW10 9NH, London, UK.
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Abstract
The goal of this study was to establish face, content, and construct validity of NOViSE—the first force-feedback enabled virtual reality (VR) simulator for natural orifice transluminal endoscopic surgery (NOTES). Fourteen surgeons and surgical trainees performed 3 simulated hybrid transgastric cholecystectomies using a flexible endoscope on NOViSE. Four of them were classified as “NOTES experts” who had independently performed 10 or more simulated or human NOTES procedures. Seven participants were classified as “Novices” and 3 as “Gastroenterologists” with no or minimal NOTES experience. A standardized 5-point Likert-type scale questionnaire was administered to assess the face and content validity. NOViSE showed good overall face and content validity. In 14 out of 15 statements pertaining to face validity (graphical appearance, endoscope and tissue behavior, overall realism), ≥50% of responses were “agree” or “strongly agree.” In terms of content validity, 85.7% of participants agreed or strongly agreed that NOViSE is a useful training tool for NOTES and 71.4% that they would recommend it to others. Construct validity was established by comparing a number of performance metrics such as task completion times, path lengths, applied forces, and so on. NOViSE demonstrated early signs of construct validity. Experts were faster and used a shorter endoscopic path length than novices in all but one task. The results indicate that NOViSE authentically recreates a transgastric hybrid cholecystectomy and sets promising foundations for the further development of a VR training curriculum for NOTES without compromising patient safety or requiring expensive animal facilities.
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Dao HV, Komeda T. Estimating Endoscopic Orientation in Static and Dynamic States With Inertial Sensors. J Med Device 2016. [DOI: 10.1115/1.4033332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
This paper presents a new method for estimating the tilt angles of endoscopic images. Disorientation is one of the major challenges during natural orifice translumenal endoscopic surgery (NOTES). Reorientation allows surgeons or gastroenterologists to work in off-axis conditions and provides an important reference for coupling a secondary image. Some published studies of angle estimation for NOTES still have the limitation under the influence of movement or vibration. This study proposes a new sensor-fusion method for reducing the shock-based error. A triaxial accelerometer measures the gravitational vector (g-components) in all static states. When motion appears, the angular velocity from a triaxial gyroscope is used to calculate the elemental changes in g-components. A so-called predict-and-choose process relies on this data to predict the future state by giving many prediction values. The relationship between these values, the newest accelerometer readings, and their variation determine the final choice. Hence, under all conditions, the gravitational components are iteratively estimated to calculate the tilt angles. The result is evaluated by being applied in a well-known application, endoscopic horizon stabilization. Compared with the reference method, the proposed method has notable advantages. The simulation and experimental results show small errors, smooth angle change, and a small delay time. The tilt angles are reliable without any cumulative error under the prolonged motion. Therefore, this study gives surgeons or gastroenterologists an improved rectified image for reorienting under off-axis conditions. Further research will identify more applications for the development of surgical instruments for NOTES.
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Affiliation(s)
- Hung V. Dao
- Graduate School of Engineering and Science, Shibaura Institute of Technology, Saitama City, Saitama 337-8570, Japan e-mail:
| | - Takashi Komeda
- Professor Bioscience and Engineering, Shibaura Institute of Technology, Saitama City, Saitama 337-8570, Japan e-mail:
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22
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Abstract
Natural orifice translumenal endoscopic surgery (NOTES) is an intense area of research, and is arguably the most significant endoscopic innovation of this decade. Training for new NOTES is a relatively long, encompassing advanced endoscopy training, mastery of endoscopic dexterity within the narrow submucosal or "third space" with an in-depth understanding of the tissue planes. Proficiency with new closure and hemostatic devices is also essential. Few institutions worldwide can provide all the cognitive and technical elements essential to train new NOTES trainees. Trainees may need to spend time across several institutions to ensure safe and effective practice of new NOTES.
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Affiliation(s)
- Payal Saxena
- Division of Gastroenterology and Hepatology, Department of Medicine, Royal Prince Alfred Hospital, Missenden Rd, Camperdown, NSW 2050, Australia; Division of Gastroenterology and Hepatology, Department of Medicine, The Johns Hopkins Medical Institutions, 1800 Orleans St, Baltimore, MD 21205, USA
| | - Mouen A Khashab
- Division of Gastroenterology and Hepatology, Department of Medicine, The Johns Hopkins Medical Institutions, 1800 Orleans St, Baltimore, MD 21205, USA; Department of Medicine, Johns Hopkins Hospital, 1800 Orleans Street, Suite 7125B, Baltimore, MD 21205, USA.
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A case of transvaginal NOTES partial gastrectomy using new techniques and devices. Surg Case Rep 2016; 1:96. [PMID: 26943420 PMCID: PMC4595414 DOI: 10.1186/s40792-015-0093-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Accepted: 10/01/2015] [Indexed: 12/05/2022] Open
Abstract
The latest technique of transvaginal NOTES partial gastrectomy is described in detail. The procedure involves new “over-tube steering” technique and usage of two newly developed endoscopic accessories. The technique is feasible, safe, and practical, since all devices used in the case are off-the-shelf products.
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Leong F, Garbin N, Natali CD, Mohammadi A, Thiruchelvam D, Oetomo D, Valdastri P. Magnetic Surgical Instruments for Robotic Abdominal Surgery. IEEE Rev Biomed Eng 2016; 9:66-78. [PMID: 26829803 DOI: 10.1109/rbme.2016.2521818] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
This review looks at the implementation of magnetic-based approaches in surgical instruments for abdominal surgeries. As abdominal surgical techniques advance toward minimizing surgical trauma, surgical instruments are enhanced to support such an objective through the exploration of magnetic-based systems. With this design approach, surgical devices are given the capabilities to be fully inserted intraabdominally to achieve access to all abdominal quadrants, without the conventional rigid link connection with the external unit. The variety of intraabdominal surgical devices are anchored, guided, and actuated by external units, with power and torque transmitted across the abdominal wall through magnetic linkage. This addresses many constraints encountered by conventional laparoscopic tools, such as loss of triangulation, fulcrum effect, and loss/lack of dexterity for surgical tasks. Design requirements of clinical considerations to aid the successful development of magnetic surgical instruments, are also discussed.
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Yip HC, Chiu PWY. Recent advances in natural orifice transluminal endoscopic surgery†. Eur J Cardiothorac Surg 2015; 49 Suppl 1:i25-30. [PMID: 26494866 DOI: 10.1093/ejcts/ezv364] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Accepted: 09/03/2015] [Indexed: 12/11/2022] Open
Abstract
Natural orifice transluminal endoscopic surgery (NOTES) has emerged as one of the most exciting areas in the field of minimally invasive surgery during the last decade. NOTES comprises a wide spectrum of procedures from various natural accesses such as transgastric or transvaginal routes, and different direct-target or distant-target organs. Since polypectomy was first performed in 1955, major advances in technology and refinement of endoscopic technique have allowed endoscopic surgeons to perform complex endoscopic interventions such as endoscopic submucosal dissection. Recognizing the safety and feasibility of submucosal tunnelling and mucosal closure, endoscopic resection beyond the level of mucosa has been increasingly reported. One of these procedures, peroral endoscopic myotomy for achalasia, has gained much popularity and excellent results have been published comparable with that of traditional Heller's cardiomyotomy. Submucosal tunnelling endoscopic resection has also been reported for tumours situated in the muscular layer of the gastrointestinal tract. To overcome the difficulty of intestinal closure after NOTES, researchers have collaborated with the industry in developing different endoscopic suturing devices such as the Eagle Claw (Olympus Medical Systems, Tokyo, Japan) and Overstitch™ (Apollo Endosurgery, Austin TX, USA). These devices allow precise and secure suture application with the ordinary flexible endoscope, achieving tissue approximation similar to open surgical suturing. To further expand the potential of NOTES, investigators had also developed multitasking platforms enabling the performance of surgical procedures of even higher complexity. Recently, a novel endoscopic robotic system 'Master and Slave Transluminal Endoscopic Robot' (MASTER) has been developed. Early results of endoscopic resection utilizing this system have been encouraging, allowing both experts and novices in endoscopy to perform difficult endoscopic resection with a high degree of flexibility.
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Affiliation(s)
- Hon-chi Yip
- Department of Surgery, Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Philip Wai-yan Chiu
- Department of Surgery, Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China Department of Surgery, Institute of Digestive Disease, Chinese University of Hong Kong, Hong Kong, China
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Donatsky AM, Andersen L, Nielsen OL, Meisner S, Jørgensen LN, Rosenberg J, Vilmann P. Gastrotomy Healing After Transgastric Peritoneoscopy: A Randomized Study in a Pig Model. J Laparoendosc Adv Surg Tech A 2015; 25:747-54. [PMID: 26275155 DOI: 10.1089/lap.2015.0271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Reliable closure and infection prevention are the main barriers for implementation of pure transgastric peritoneoscopy. The primary aim of this study was to assess healing of over the scope clip (OTSC) closed gastrotomies. MATERIALS AND METHODS Pure transgastric peritoneoscopy was performed in 7 pigs. The pigs were randomized to 14 or 28 postoperative days (POD) of follow-up. Decontamination of the access route was performed before instrumentation. A full necropsy was performed. Closure was evaluated with histopathological examination of excised gastrorrhaphies. RESULTS Three pigs were allowed 14 POD of follow-up, and 4 pigs were allowed 28 POD of follow-up. Survival was achieved in 6 of the 7 animals; 1 pig was euthanized due to diffuse peritonitis. Based on our definition, full-thickness healing had only been achieved in a single pig allowed 28 POD. With respect to clinical relevancy, full-thickness healing was deemed achieved in 4 of 6 pigs completing follow-up and in all pigs allowed and surviving 28 POD. Access required repeated punctures and the use of several endoscopic instruments. CONCLUSIONS Full-thickness healing of the gastrotomy was only found in a single case when adhering to the per protocol definition. Endoscopic ultrasonography-guided access was difficult. It lacks reproducibility and needs refinement. Despite a combined decontamination regimen, infectious complications still occurred.
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Affiliation(s)
- Anders Meller Donatsky
- 1 Department of Surgery, Hvidovre Hospital, University of Copenhagen , Hvidovre, Denmark
| | - Luise Andersen
- 2 Department of Pathology, Roskilde Hospital, University of Copenhagen , Roskilde, Denmark
| | - Ole Lerberg Nielsen
- 3 Department of Veterinary Disease Biology, Faculty of Health and Medical Sciences, University of Copenhagen , Frederiksberg, Denmark
| | - Søren Meisner
- 4 Digestive Disease Center, Bispebjerg Hospital, University of Copenhagen , Copenhagen, Denmark
| | | | - Jacob Rosenberg
- 5 Department of Surgery, Herlev Hospital, University of Copenhagen , Herlev, Denmark
| | - Peter Vilmann
- 5 Department of Surgery, Herlev Hospital, University of Copenhagen , Herlev, Denmark
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Atallah S, Martin-Perez B, Keller D, Burke J, Hunter L. Natural-orifice transluminal endoscopic surgery. Br J Surg 2015; 102:e73-92. [PMID: 25627137 DOI: 10.1002/bjs.9710] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Accepted: 10/20/2014] [Indexed: 02/06/2023]
Abstract
BACKGROUND Natural-orifice transluminal endoscopic surgery (NOTES) represents one of the most significant innovations in surgery to emerge since the advent of laparoscopy. A decade of progress with this approach has now been catalogued, and yet its clinical application remains controversial. METHODS A PubMed search was carried out for articles describing NOTES in both the preclinical and the clinical setting. Public perceptions and expert opinion regarding NOTES in the published literature were analysed carefully. RESULTS Two hundred relevant articles on NOTES were studied and the outcomes reviewed. A division between direct- and indirect-target NOTES was established. The areas with the most promising clinical application included direct-target NOTES, such as transanal total mesorectal excision and peroral endoscopic myotomy. The clinical experience with distant-target NOTES, such as for appendicectomy and cholecystectomy, showed feasibility; however, NOTES-specific morbidity was introduced and this represents an important limitation. CONCLUSION NOTES experimentation in the preclinical setting has increased substantially. There has also been a significant increase in the application of NOTES in humans in the past decade. Enthusiasm for NOTES should be tempered by the risk of incurring NOTES-specific morbidity. Surgeons should carefully consider patient preferences regarding this new minimally invasive option, as opinions are not unanimously supportive of NOTES. As technical limitations are overcome, the clinical application of NOTES is predicted to increase. It is paramount that, when this complex technique is performed on humans, it is applied judiciously by appropriately trained experts with outcomes recorded in a registry.
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Affiliation(s)
- S Atallah
- Department of Colon and Rectal Surgery, Florida Hospital, Orlando, Florida
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Fuchs KH. Comments on the current status and future development of natural orifice transluminal endoscopic surgery. ANZ J Surg 2015; 85:201-2. [DOI: 10.1111/ans.12984] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Clinical impact of submucosal tunneling endoscopic resection for the treatment of gastric submucosal tumors originating from the muscularis propria layer (with video). Surg Endosc 2015; 29:3640-6. [PMID: 25740640 DOI: 10.1007/s00464-015-4120-2] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Accepted: 02/02/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND Submucosal tunneling endoscopic resection (STER) can be adequately adopted as an effective treatment for submucosal tumors (SMTs) originating from the muscularis propria (MP) layer at the esophagus and cardia. However, it has been seldom used for gastric SMTs. Our purpose was to evaluate the clinical impact of STER for gastric SMTs arising from the MP layer. METHODS Thirty-two patients with gastric SMTs from the MP layer were retrospectively included. The main outcome measurements were complete resection rate, adverse events, local recurrence, and distant metastases during follow-up. RESULTS Of the 32 lesions, 12 were located in the gastric corpus close to the cardia, 3 in the gastric fundus close to the cardia, 6 in the lesser curvature of the gastric corpus, and 11 in the greater curvature of the gastric antrum. STER was successfully performed in all patients with en bloc resection of tumors. The mean tumor size was 2.3 cm (range 1.0-5.0 cm). The complete resection rate was 100%. The operation time ranged from 25 to 125 min (mean 51.8 min). All complications related to STER were successfully managed with conservative treatments. Local recurrence or distant metastasis did not occur during a follow-up period of 6-32 months. CONCLUSION STER is a safe and effective therapeutic strategy for eligible gastric SMTs originating from the MP layer. Submucosal tunneling in the stomach may be more challenging than that in the esophagus, but does not increase procedure-related adverse events or prevent successful STER for eligible gastric SMTs.
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Feussner H, Fiolka A, Schneider A, Cuntz T, Coy J, von Tiesenhausen C, Höller K, Weede O, Konietschke R, Borchard JH, Ellrichmann M, Reiser S, Ortmaier T. The "Iceberg Phenomenon": As Soon as One Technological Problem in NOTES Is Solved, the Next One Appears! Surg Innov 2015; 22:643-50. [PMID: 25733547 DOI: 10.1177/1553350615573578] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Though already proclaimed about 7 years ago, natural orifice transluminal endoscopic surgery (NOTES) is still in its early stages. A multidisciplinary working team tried to analyze the technical obstacles and identify potential solutions. METHODS After a comprehensive review of the literature, a group of 3 surgeons, 1 gastroenterologist, 10 engineers, and 1 representative of biomedical industry defined the most important deficiencies within the system and then compiled as well as evaluated innovative technologies that could be used to help overcome these problems. These technologies were classified with regard to the time needed for their implementation and associated hindrances, where priority is based on the level of impact and significance that it would make. RESULTS Both visualization and actuation require significant improvement. Advanced illumination, mist elimination, image stabilization, view extension, 3-dimensional stereoscopy, and augmented reality are feasible options and could optimize visual information. Advanced mechatronic platforms with miniaturized, powerful actuators, and intuitive human-machine interfaces could optimize dexterity, as long as enabling technologies are used. The latter include depth maps in real time, precise navigation, fast pattern recognition, partial autonomy, and cognition systems. CONCLUSION The majority of functional deficiencies that still exist in NOTES platforms could be overcome by a broad range of already existing or emerging enabling technologies. To combine them in an optimal manner, a permanent dialogue between researchers and clinicians is mandatory.
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Affiliation(s)
| | - Adam Fiolka
- Technical University of Munich, Munich, Germany
| | | | - Timo Cuntz
- Fraunhofer Project Group for Automation in Medicine and Biotechnology (PAMB), Mannheim, Germany
| | | | | | - Kurt Höller
- Friedrich-Alexander University, Erlangen-Nürnberg, Germany
| | - Oliver Weede
- Karlsruhe Institute of Technology, Karlsruhe, Germany
| | | | | | - Mark Ellrichmann
- University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
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Zygomalas A, Kehagias I, Giokas K, Koutsouris D. Miniature Surgical Robots in the Era of NOTES and LESS. Surg Innov 2015; 22:97-107. [DOI: 10.1177/1553350614532549] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Abstract
Laparoscopy is an established method for the treatment of numerous surgical conditions. Natural orifice transluminal endoscopic surgery (NOTES) is a novel surgical technique that uses the natural orifices of the human body as entrances to the abdominal cavity. An alternative concept of minimally invasive approach to the abdominal cavity is to insert all the laparoscopic instruments through ports using a single small incision on the abdominal wall. A suggested name for this technique is laparoendoscopic single-site surgery (LESS). Considering the technical difficulties in NOTES and LESS and the progress in informatics and robotics, the use of robots seems ideal. The aim of this study is to investigate if there is at present, a realistic possibility of using miniature robots in NOTES or LESS in daily clinical practice. An up-to-date review on in vivo surgical miniature robots is made. A Web-based research of the English literature up to March 2013 using PubMed, Scopus, and Google Scholar as search engines was performed. The development of in vivo miniature robots for use in NOTES or LESS is a reality with great advancements, potential advantages, and possible application in minimally invasive surgery in the future. However, true totally NOTES or LESS procedures on humans using miniature robots either solely or as assistance, remain a dream at present.
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Daher R, Chouillard E, Panis Y. New trends in colorectal surgery: Single port and natural orifice techniques. World J Gastroenterol 2014; 20:18104-18120. [PMID: 25561780 PMCID: PMC4277950 DOI: 10.3748/wjg.v20.i48.18104] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Revised: 07/28/2014] [Accepted: 10/15/2014] [Indexed: 02/06/2023] Open
Abstract
Single-incision laparoscopic surgery (SILS) and natural orifice transluminal endoscopic surgery (NOTES) have rapidly gained pace worldwide, potentially replacing conventional laparoscopic surgery (CLS) as the preferred colorectal surgery technique. Currently available data mainly consist of retrospective series analyzed in four meta-analyses. Despite conflicting results and lack of an objective comparison, SILS appears to offer cosmetic advantages over CLS. However, due to conflicting results and marked heterogeneity, present data fail to show significant differences in terms of operative time, postoperative morbidity profiles, port-site complications rates, oncological appropriateness, duration of hospitalization or cost when comparing SILS with conventional laparoscopy for colorectal procedures. The application of “pure” NOTES in humans remains limited to case reports because of unresolved issues concerning the ideal access site, distant organ reach, spatial orientation and viscera closure. Alternatively, minilaparoscopy-assisted natural orifice surgery techniques are being developed. The transanal “down-to-up” total mesorectum excision has been derived for transanal endoscopic microsurgery (TEM) and represents the most encouraging NOTES-derived technique. Preliminary experiences demonstrate good oncological and functional short-term outcomes. Large-scale randomized controlled trials are now mandatory to confirm the long-term SILS results and validate transanal TEM for the application of NOTES in humans.
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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: 10] [Impact Index Per Article: 0.9] [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.
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In silico investigation of a surgical interface for remote control of modular miniature robots in minimally invasive surgery. Minim Invasive Surg 2014; 2014:307641. [PMID: 25295187 PMCID: PMC4175786 DOI: 10.1155/2014/307641] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Accepted: 08/03/2014] [Indexed: 11/20/2022] Open
Abstract
Aim. Modular mini-robots can be used in novel minimally invasive surgery techniques like natural orifice transluminal endoscopic surgery (NOTES) and laparoendoscopic single site (LESS) surgery. The control of these miniature assistants is complicated. The aim of this study is the in silico investigation of a remote controlling interface for modular miniature robots which can be used in minimally invasive surgery. Methods. The conceptual controlling system was developed, programmed, and simulated using professional robotics simulation software. Three different modes of control were programmed. The remote controlling surgical interface was virtually designed as a high scale representation of the respective modular mini-robot, therefore a modular controlling system itself. Results. With the proposed modular controlling system the user could easily identify the conformation of the modular mini-robot and adequately modify it as needed. The arrangement of each module was always known. The in silico investigation gave useful information regarding the controlling mode, the adequate speed of rearrangements, and the number of modules needed for efficient working tasks. Conclusions. The proposed conceptual model may promote the research and development of more sophisticated modular controlling systems. Modular surgical interfaces may improve the handling and the dexterity of modular miniature robots during minimally invasive procedures.
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A novel flexible hyper-redundant surgical robot: prototype evaluation using a single incision flexible access pelvic application as a clinical exemplar. Surg Endosc 2014; 29:658-67. [DOI: 10.1007/s00464-014-3716-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2013] [Accepted: 06/25/2014] [Indexed: 10/24/2022]
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Stefanidis D, Fanelli RD, Price R, Richardson W. SAGES guidelines for the introduction of new technology and techniques. Surg Endosc 2014; 28:2257-2271. [PMID: 24939155 DOI: 10.1007/s00464-014-3587-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Accepted: 04/26/2014] [Indexed: 02/06/2023]
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Park SJ, Sohn DK, Chang TY, Jung Y, Kim HJ, Kim YI, Chun HK. Transanal natural orifice transluminal endoscopic surgery total mesorectal excision in animal models: endoscopic inferior mesenteric artery dissection made easier by a retroperitoneal approach. Ann Surg Treat Res 2014; 87:1-4. [PMID: 25025019 PMCID: PMC4091439 DOI: 10.4174/astr.2014.87.1.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Revised: 02/13/2014] [Accepted: 03/04/2014] [Indexed: 02/08/2023] Open
Abstract
Purpose We report the performance of natural orifice transluminal endoscopic surgery (NOTES) low anterior resection in animals using transanal total mesorectal excision (TME) with laparoscopic assistance and endoscopic inferior mesenteric artery (IMA) dissection. Methods Four pigs weighing 45 kg each, and one dog weighing 25 kg, underwent surgery via a transanal approach. The rectum was occluded transanally using a purse-string suture, approximately 3-4 cm from the anal verge. The rectal mucosa was incised circumferentially just distal to the purse-string. A SILS or GelPOINT port was inserted transanally. Transanal TME was assisted by laparoscopy and proceeded up to the peritoneal reflection. More proximal dissection, including IMA dissection, was performed along the retroperitoneal avascular plane by endoscopy alone and facilitated by CO2 insufflation. The IMA was clipped and divided endoscopically. The mobilized rectosigmoid were exteriorized transanally and transected. A colorectal anastomosis was performed using a circular stapler with a single stapling technique. Results Endoscopic dissection of the IMA was successful in all five animals. The mean operation time was 125 minutes (range, 90-170 minutes). There were no intraoperative complications or hemodynamic instability. The mean length of the resected specimen was 14.4 cm (range, 12-16 cm). Conclusion A NOTES retroperitoneal approach to the IMA with CO2 insufflation and intact peritoneal covering overcame the difficulties of retraction and exposure of endoscopic dissection in animals.
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Affiliation(s)
- Sun Jin Park
- Department of Surgery, Kyung Hee University School of Medicine, Seoul, Korea
| | - Dae Kyung Sohn
- Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Tae Young Chang
- Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Yunho Jung
- Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Hyung Jin Kim
- Department of Surgery, St. Vincent's Hospital, The Catholic University of Korea College of Medicine, Suwon, Korea
| | | | - Ho-Kyung Chun
- Department of Surgery, Kangbuk Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Abstract
Laparoscopy is an established method for the treatment of numerous surgical conditions. Natural orifice transluminal endoscopic surgery (NOTES) is a novel surgical technique that uses the natural orifices of the human body as entrances to the abdominal cavity. An alternative concept of minimally invasive approach to the abdominal cavity is to insert all the laparoscopic instruments through ports using a single small incision on the abdominal wall. A suggested name for this technique is laparoendoscopic single-site surgery (LESS). Considering the technical difficulties in NOTES and LESS and the progress in informatics and robotics, the use of robots seems ideal. The aim of this study is to investigate if there is at present, a realistic possibility of using miniature robots in NOTES or LESS in daily clinical practice. An up-to-date review on in vivo surgical miniature robots is made. A Web-based research of the English literature up to March 2013 using PubMed, Scopus, and Google Scholar as search engines was performed. The development of in vivo miniature robots for use in NOTES or LESS is a reality with great advancements, potential advantages, and possible application in minimally invasive surgery in the future. However, true totally NOTES or LESS procedures on humans using miniature robots either solely or as assistance, remain a dream at present.
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Emhoff IA, Lee GC, Sylla P. Future directions in surgery for colorectal cancer: the evolving role of transanal endoscopic surgery. COLORECTAL CANCER 2014. [DOI: 10.2217/crc.14.8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
SUMMARY The morbidity associated with radical surgery for rectal cancer has launched a revolution in increasingly less-invasive methods of resection, including a recent resurgence in transanal endoscopic surgical approaches. The next evolution in transanal surgery for rectal cancer is natural orifice translumenal endoscopic surgery (NOTES). To date, 14 series of transanal NOTES total mesorectal excision (TME) for rectal cancer have been published (n = 76). Overall, the intraoperative and postoperative complication rates of 8 and 28%, respectively, compare favorably to those expected from laparoscopic and open TME. Short-term follow-up after NOTES TME has yielded no cancer recurrence in average-risk patients. High-risk patients have cancer recurrence rates similar to those after laparoscopic TME. Overall, these early data support transanal NOTES TME as a safe and viable alternative to conventional TME. Advances in instrumentation, surgical expertise and neoadjuvant treatment may expand current indications for NOTES even further.
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Affiliation(s)
- Isha Ann Emhoff
- Department of Surgery, Division of Gastrointestinal Surgery, Massachusetts General Hospital, 15 Parkman Street, Wang 460, Boston, MA 02114, USA
| | - Grace Clara Lee
- Department of Surgery, Division of Gastrointestinal Surgery, Massachusetts General Hospital, 15 Parkman Street, Wang 460, Boston, MA 02114, USA
| | - Patricia Sylla
- Department of Surgery, Division of Gastrointestinal Surgery, Massachusetts General Hospital, 15 Parkman Street, Wang 460, Boston, MA 02114, USA
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A comparison of NOTES transvaginal and laparoscopic cholecystectomy procedures based upon task analysis. Surg Endosc 2014; 28:2443-51. [PMID: 24619331 DOI: 10.1007/s00464-014-3495-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Accepted: 02/17/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND A virtual reality-based simulator for natural orifice translumenal endoscopic surgery (NOTES) procedures may be used for training and discovery of new tools and procedures. Our previous study (Sankaranarayanan et al. in Surg Endosc 27:1607-1616, 2013) shows that developing such a simulator for the transvaginal cholecystectomy procedure using a rigid endoscope will have the most impact on the field. However, prior to developing such a simulator, a thorough task analysis is necessary to determine the most important phases, tasks, and subtasks of this procedure. METHODS 19 rigid endoscope transvaginal hybrid NOTES cholecystectomy procedures and 11 traditional laparoscopic procedures have been recorded and de-identified prior to analysis. Hierarchical task analysis was conducted for the rigid endoscope transvaginal NOTES cholecystectomy. A time series analysis was conducted to evaluate the performance of the transvaginal NOTES and laparoscopic cholecystectomy procedures. Finally, a comparison of electrosurgery-based errors was performed by two independent qualified personnel. RESULTS The most time-consuming tasks for both laparoscopic and NOTES cholecystectomy are removing areolar and connective tissue surrounding the gallbladder, exposing Calot's triangle, and dissecting the gallbladder off the liver bed with electrosurgery. There is a positive correlation of performance time between the removal of areolar and connective tissue and electrosurgery dissection tasks in NOTES (r = 0.415) and laparoscopic cholecystectomy (r = 0.684) with p < 0.10. During the electrosurgery task, the NOTES procedures had fewer errors related to lack of progress in gallbladder removal. Contrarily, laparoscopic procedures had fewer errors due to the instrument being out of the camera view. CONCLUSION A thorough task analysis and video-based quantification of NOTES cholecystectomy has identified the most time-consuming tasks. A comparison of the surgical errors during electrosurgery gallbladder dissection establishes that the NOTES procedure, while still new, is not inferior to the established laparoscopic procedure.
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Kim CG. Natural orifice transluminal endoscopic surgery and upper gastrointestinal tract. J Gastric Cancer 2013; 13:199-206. [PMID: 24511415 PMCID: PMC3915181 DOI: 10.5230/jgc.2013.13.4.199] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Revised: 12/16/2013] [Accepted: 12/17/2013] [Indexed: 12/18/2022] Open
Abstract
Since the first transgastric natural orifice transluminal endoscopic surgery was described, various applications and modified procedures have been investigated. Transgastric natural orifice transluminal endoscopic surgery for periotoneoscopy, cholecystectomy, and appendectomy all seem viable in humans, but additional studies are required to demonstrate their benefits and roles in clinical practice. The submucosal tunneling method enhances the safety of peritoneal access and gastric closure and minimizes the risk of intraperitoneal leakage of gastric air and juice. Submucosal tunneling involves submucosal tumor resection and peroral endoscopic myotomy. Peroral endoscopic myotomy is a safe and effective treatment option for achalasia, and the most promising natural orifice transluminal endoscopic surgery procedure. Endoscopic full-thickness resection is a rapidly developing natural orifice transluminal endoscopic surgery procedure for the upper gastrointestinal tract and can be performed with a hybrid natural orifice transluminal endoscopic surgery technique (combining a laparoscopic approach) to overcome some limitations of pure natural orifice transluminal endoscopic surgery. Studies to identify the most appropriate role of endoscopic full-thickness resection are anticipated. In this article, I review the procedures of natural orifice transluminal endoscopic surgery associated with the upper gastrointestinal tract.
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Affiliation(s)
- Chan Gyoo Kim
- Center for Gastric Cancer, National Cancer Center, Goyang, Korea
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Barajas-Gamboa JS, Jacobsen GR. Transvaginal Hybrid NOTES Cholecystectomy: Current Techniques and Advantages. CURRENT SURGERY REPORTS 2013. [DOI: 10.1007/s40137-013-0029-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Liu L, Chiu PWY, Teoh AYB, Lam CCH, Ng EKW, Lau JYW. Endoscopic suturing is superior to endoclips for closure of gastrotomy after natural orifices translumenal endoscopic surgery (NOTES): an ex vivo study. Surg Endosc 2013; 28:1342-7. [DOI: 10.1007/s00464-013-3280-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2013] [Accepted: 10/06/2013] [Indexed: 12/17/2022]
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Zygomalas A, Giokas K, Koutsouris D. Modular Assembly Micro-Robots for Natural Orifice Transluminal Endoscopic Surgery. ROBOTICS 2013. [DOI: 10.4018/978-1-4666-4607-0.ch078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Surgical operations are progressively being performed using minimally invasive techniques. Natural Orifice Transluminal Endoscopic Surgery (NOTES) is a novel surgical technique that uses the natural orifices of the human body in order to approach the peritoneal cavity. There are two basic types of robotics for NOTES; the external robots that stay outside the patient but act inside the abdominal cavity, and the internal robots that stay and act in the abdomen. The internal robots could only be mini-robots. The development of modular assembling reconfigurable micro-robots is a revolutionary idea for the NOTES. Modular micro-robots consist of small subunits which could be assembled and construct a functional miniature robot. These surgical micro-robots may increase the possibility for true scarless tele-surgery. Although specific applications of intrabdominal surgical micro-robots are still in an early concept stage, the field is rapidly evolving. In the future, patients may be operated by specialized micro-robotic intrabdominal surgeons.
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Affiliation(s)
- Apollon Zygomalas
- University of Patras, Greece & University Hospital of Patras, Greece
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Li QL, Chen WF, Zhou PH, Yao LQ, Xu MD, Hu JW, Cai MY, Zhang YQ, Qin WZ, Ren Z. Peroral endoscopic myotomy for the treatment of achalasia: a clinical comparative study of endoscopic full-thickness and circular muscle myotomy. J Am Coll Surg 2013; 217:442-51. [PMID: 23891074 DOI: 10.1016/j.jamcollsurg.2013.04.033] [Citation(s) in RCA: 124] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2013] [Revised: 04/01/2013] [Accepted: 04/23/2013] [Indexed: 12/13/2022]
Abstract
BACKGROUND A circular muscle myotomy preserving the longitudinal outer esophageal muscular layer is often recommended during peroral endoscopic myotomy (POEM) for achalasia. However, because the longitudinal muscle fibers of the esophagus are extremely thin and fragile, and completeness of myotomy is the basis for the excellent results of conventional surgical myotomy, this modification needs to be further debated. Here, we retrospectively analyzed our prospectively maintained POEM database to compare the outcomes of endoscopic full-thickness and circular muscle myotomy. STUDY DESIGN According to the myotomy depth, 103 patients with full-thickness myotomy were assigned to group A, while 131 patients with circular muscle myotomy were assigned to group B. Symptom relief, procedure-related parameters and adverse events, manometry outcomes, and reflux complications were compared between groups. RESULTS The mean operation times were significantly shorter in group A compared with group B (p = 0.02). There was no increase in any procedure-related adverse event after full-thickness myotomy (all p < 0.05). During follow-up, treatment success (Eckardt score ≤ 3) persisted for 96.0% (95 of 99) of patients in group A and for 95.0% (115 of 121) of patients in group B (p = 0.75). There were no statistically significant differences in pre- and post-treatment D-value of symptom scores and lower esophageal sphincter pressures between groups (both p > 0.05). The overall clinical reflux complication rates were also similar (21.2% vs 16.5%, p = 0.38). CONCLUSIONS Short-term symptom relief and manometry outcomes of each method were comparable. Full-thickness myotomy significantly reduced the procedure time but did not increase the procedure-related adverse events or clinical reflux complications.
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Affiliation(s)
- Quan-Lin Li
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China
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Renteln DV, Vassiliou MC, Rösch T. Training for peroral endoscopic myotomy. TECHNIQUES IN GASTROINTESTINAL ENDOSCOPY 2013; 15:153-156. [DOI: 10.1016/j.tgie.2013.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Fuchs KH, Meining A, von Renteln D, Fernandez-Esparrach G, Breithaupt W, Zornig C, Lacy A. Euro-NOTES Status Paper: from the concept to clinical practice. Surg Endosc 2013; 27:1456-1467. [PMID: 23543284 DOI: 10.1007/s00464-013-2870-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2012] [Accepted: 02/01/2013] [Indexed: 02/08/2023]
Abstract
BACKGROUND The concept of natural orifice transluminal endoscopic surgery (NOTES) consists of the reduction of access trauma by using a natural orifice access to the intra-abdominal cavity. This could possibly lead to less postoperative pain, quicker recovery from surgery, fewer postoperative complications, fewer wound infections, and fewer long-term problems such as hernias. The Euro-NOTES Foundation has organized yearly meetings to work on this concept to bring it safely into clinical practice. The aim of this Euro-NOTES status update is to assess the yearly scientific working group reports and provide an overview on the current clinical practice of NOTES procedures. METHODS After the Euro-NOTES meeting 2011 in Frankfurt, Germany, an analysis was started regarding the most important topics of the European working groups. All prospectively documented information was gathered from Euro-NOTES and D-NOTES working groups from 2007 to 2011. The top five topics were analyzed. RESULTS The statements of the working group activities demonstrate the growing information and changing insights. The most important selected topics were infection issue, peritoneal access, education and training, platforms and new technology, closure, suture, and anastomosis. The focus on research topics changed over time. The principle of hybrid access has overcome the technical and safety limitations of pure NOTES. Currently the following NOTES access routes are established for several indications: transvaginal access for cholecystectomy, appendectomy and colon resections; transesophageal access for myotomy; transgastric access for full-thickness small-tumor resections; and transanal/transcolonic access for rectal and colon resections. CONCLUSIONS NOTES and hybrid NOTES techniques have emerged for all natural orifices and were introduced into clinical practice with a good safety record. There are different indications for different natural orifices. Each technique has been optimized for the purpose of finding a safe and realistic solution to perform the procedure according to the specific indication.
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Affiliation(s)
- K H Fuchs
- Department of Surgery, AGAPLESION-Markus-Krankenhaus, Wilhelm-Epstein-Str. 4, Frankfurt, Germany.
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ZHOU YUE, REN HONGLIANG, MENG MAXQH, TSZ HO TSE ZION, YU HAOYONG. ROBOTICS IN NATURAL ORIFICE TRANSLUMINAL ENDOSCOPIC SURGERY. J MECH MED BIOL 2013. [DOI: 10.1142/s0219519413500449] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Natural orifice translumenal endoscopic surgery (NOTES) is the latest surgery paradigm in which the abdominal cavity is accessed via the body's natural orifice, e.g., vagina, mouth, etc. Compared with traditional laparoscopic surgery, NOTES completely eliminates the skin incision and therefore benefits the patients in several aspects such as less post-operative pain, shorter recovery period, fewer complications, etc. Due to the unique characteristics of NOTES, instruments for traditional laparoscopic surgery are not suitable for NOTES and hence novel hardware design is necessary for facilitating system development. This paper gives an overview of the state of the arts in the development of surgical instruments for NOTES, particularly with a focus on the promising robotic endoscopes.
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Affiliation(s)
- YUE ZHOU
- Department of Bioengineering, National University of Singapore, Singapore 117575, Singapore
- Electronic Engineering Department, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong
| | - HONGLIANG REN
- Department of Bioengineering, National University of Singapore, Singapore 117575, Singapore
| | - MAX Q.-H. MENG
- Electronic Engineering Department, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong
| | - ZION TSZ HO TSE
- College of Engineering, University of Georgia, Athens, GA, 30602, USA
| | - HAOYONG YU
- Department of Bioengineering, National University of Singapore, Singapore 117575, Singapore
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Beuran M, Negoi I, Paun S, Lobontiu A, Filipoiu F, Moldoveanu A, Negoi R, Hostiuc S. Natural orifice translumenal endoscopic surgery (NOTES) second-look peritoneoscopy for staging of limited peritoneal carcinomatosis. Med Hypotheses 2013; 80:745-9. [PMID: 23562285 DOI: 10.1016/j.mehy.2013.03.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2012] [Revised: 02/12/2013] [Accepted: 03/03/2013] [Indexed: 11/17/2022]
Abstract
BACKGROUND Over the past decades, staging laparoscopy evolved as a useful tool in multimodality treatment of patients with abdominal malignancies, especially for detection of incurable peritoneal and liver metastasis. Natural orifice translumenal endoscopic surgery (NOTES) is a new, evolving technique which represents the next logical progression in minimally invasive surgery and has theoretical advantages in comparison with standard laparoscopic surgery. A review of the current literature revealed a continuous increasing number of fundamental and clinical studies addressing NOTES approach in multimodal management of oncologic patients. Technical possibility to use this new minimally invasive approach for oncological resection of abdominal malignancies was proved by some investigators. HYPOTHESIS NOTES can be used as an alternative method for staging patients with limited peritoneal carcinomatosis and may have better results compared to current imaging techniques for small diameter metastatic disease. CONCLUSIONS With the continuous development of the NOTES techniques and technology, the second-look peritoneoscopy by NOTES may become an alternative method for staging in patients with peritoneal carcinomatosis. Nevertheless, NOTES is at a very early stage of its development, and its implementation in oncologic surgery should be made very caution, and only after careful evaluation.
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Affiliation(s)
- Mircea Beuran
- General Surgery Department, Emergency Hospital of Bucharest, University of Medicine and Pharmacy Carol Davila Bucharest, Romania
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