Abstract
Background
Natural orifice translumenal endoscopic surgery (NOTES) is an emerging field in minimally invasive surgery that is driving the development of new technology and techniques. There are several proposed benefits to the NOTES approach, including potentially decreased abdominal pain, wound infections, and hernia formation Ko and Kalloo (Chin J Dig Dis 7:67–70, 2006); Wagh et al. (Clin Gastroenterol Hepatol 3(9):892–896, 2005); ASGE/SAGES Working Group on Natural Orifice Transluminal Endoscopic Surgery (Gastrointest Endosc 63(2):199–203, 2006); and Pearl and Ponsky (J GI Surg 12:1293–1300, 2008). Cholecystectomy has been one of the most commonly performed NOTES procedures to date, with the majority being performed through the transvaginal approach Marescaux et al. (Arch Surg 142:823–826, 2007); Zorron et al. (Surg Endosc 22:542–547, 2008); and Ramos et al. (Endoscopy 40:572–575, 2008). Transgastric approaches for cholecystectomy have been shown to be technically feasible in animal models and in several unpublished human patients Sumiyama et al. (Gastrointest Endosc 65(7):1028–1034, 2007). This video demonstrates the technique by which we perform transgastric NOTES hybrid cholecystectomy in human patients.
Method
Patients with symptomatic gallstone disease are enrolled under an IRB approved protocol. A diagnostic EGD is performed to confirm normal anatomy. Peritoneal access is gained using a needle-knife cautery and balloon dilation under laparoscopic visualization. Dissection of the critical view of safety is performed endoscopically. The cystic duct and artery are clipped laparoscopically and the gallbladder is dissected off of the liver. The gastrotomy is closed intralumenally and over-sewed laparoscopically. The gallbladder is extracted out the mouth.
Results
This technique was used to successfully perform four NOTES hybrid transgastric cholecystectomies without operative complications.
Conclusions
NOTES hybrid transgastric cholecystectomy can be performed safely in human patients. This procedure is still technically challenging given the current instrumentation that is available. In order to perform a pure NOTES transgastric cholecystectomy, a safe blind access method, improved retraction, endoscopic hemostatic clips, and reliable closure methods need to be developed.
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References
Ko CW, Kalloo AN. Per-oral transgastric abdominal surgery. Chin J Dig Dis 2006;7:67–70. doi:10.1111/j.1443-9573.2006.00256.x.
Wagh MS, Merrifield BF, Thompson CC. Endoscopic transgastric abdominal exploration and organ resection: initial experience in a porcine model. Clin Gastroenterol Hepatol 2005;3(9):892–896. doi:10.1016/S1542-3565(05)00296-X.
ASGE/SAGES Working Group on Natural Orifice Transluminal Endoscopic Surgery. White Paper, October 2005. Gastrointest Endosc 2006;63(2):199–203. doi:10.1016/j.gie.2005.12.007.
Pearl JP, Ponsky JL. Natural orifice translumenal endoscopic surgery: a critical review. J GI Surg 2008;12:1293–1300. doi:10.1007/s11605-007-0424-4.
Marescaux J, Dallemagne B, Peretta S, Wattiez A, Mutter D, Coumaros D. Surgery without scars: report of transluminal cholecystectomy in a human being. Arch Surg 2007;142:823–826. doi:10.1001/archsurg.142.9.823.
Zorron R, Maggioni LC, Pombo L, Oliverira AL, Carvalho GL, Filgueiras M. NOTES transvaginal cholecystectomy: preliminary clinical application. Surg Endosc 2008;22:542–547. doi:10.1007/s00464-007-9646-5.
Ramos AC, Murakami A, Galvao NM, Galvao MS, Silva AC, Canseco EG, Moyses Y. NOTES transvaginal video-assisted cholecystectomy: first series. Endoscopy 2008;40:572–575. doi:10.1055/s-2008-1077398.
Sumiyama K, Gostout CJ, Rajan E, Bakken TA, Knipschield MA, Chung S, Cotton PB, Hawes RH, Kalloo AN, Kantsevoy SV, Pasricha PJ. Transgastric cholecystectomy: transgastric accessibility to the gallbladder improved with the SEMF method and a novel multibending therapeutic endoscope. Gastrointest Endosc 2007;65(7):1028–1034. doi:10.1016/j.gie.2007.01.010.
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Auyang, E.D., Hungness, E.S., Vaziri, K. et al. Human NOTES Cholecystectomy: Transgastric Hybrid Technique. J Gastrointest Surg 13, 1149–1150 (2009). https://doi.org/10.1007/s11605-009-0813-y
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DOI: https://doi.org/10.1007/s11605-009-0813-y