An innovative, safe and sterile sigmoid access (ISSA) for 			 NOTES

Wilhelm, Dirk; Meining, Alexander; Delius, Stefan von; Fiolka, A.; Can, S.; Weyhern, Claus Hann von; Schneider, Armin; Feußner, H.

doi:10.1055/s-2007-966438

Cited by 129 publications

(97 citation statements)

References 19 publications

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“…The first reports described transcolonic peritoneoscopy [10,11] (n = 6) and cholecystectomy [12] (n = 5) in swine survival models with septic complications occu rring in 1 animal (9%) following incomplete closure of the anterior colotomy [12] . Subsequent reports have described transcolonic surgical procedures of increasing complexity such as ventral hernia repair [13] and distal pancreatectomy [14] in survival swine models with good results.…”

Section: Advantages Of Transcolonic/ Transanal Notes Accessmentioning

confidence: 99%

“…As described by Wilhelm et al [10] , transcolonic peritoneoscopy is facilitated by the use of the transanal endoscopic microsurgery (TEM) platform through which specialized instruments can be introduced. TEM was first introduced in 1983 as a technique to excise mid to high rectal adenomas not amenable to colonoscopic or transanal resection due to location, size, or risk of incomplete res ection or colonic perforation.…”

Section: Advantages Of Transcolonic/ Transanal Notes Accessmentioning

confidence: 99%

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NOTES in the management of colorectal diseases: Current experience and future directions

Sylla

2010

WJGS

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Clinical implementation and widespread application of natural orifice translumenal surgery (NOTES) has been limited by the lack of specialized endoscopic equipment, which has prevented the ability to perform complex procedures including colorectal resections. Relative to other types of translumenal access, transanal NOTES using transanal endoscopic microsurgery (TEM) provides a stable platform for endolumenal and direct translu menal access to the peritoneal cavity, and specifically to the colon and rectum. Completely NOTES transanal rectosigmoid resection using TEM, with or without transgastric endoscopic assistance, was demonstrated to be feasible and safe in a swine survival model. The same technique was successfully replicated in human cadavers using commercially available TEM, with end oscopic and laparoscopic instrumentation. This approach also permitted complete rectal mobilization with total mesorectal excision to be performed completely tra nsanally. As in the swine model, transgastric and/or transanal endoscopic assistance extended the length of proximal colon mobilized and overcame some of the difficulties with TEM dissection including limited end oscopic visualization and maladapted instrumentation. This extensive laboratory experience with NOTES tra nsanal rectosigmoid resection served as the basis for the first human NOTES transanal rectal cancer excision using TEM and laparoscopic assistance. Based on this early clinical experience, NOTES transanal approach using TEM holds significant promise as a safe and substantially less morbid alternative to conventional colorectal resection in the management of benign and malignant colorectal diseases. Careful patient selection and substantial impr ovement in NOTES instrumentation are critical to optimize this approach prior to widespread clinical application, and may ultimately permit completely NOTES transanal colorectal resection.

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Section: Advantages Of Transcolonic/ Transanal Notes Accessmentioning

confidence: 99%

Section: Advantages Of Transcolonic/ Transanal Notes Accessmentioning

confidence: 99%

NOTES in the management of colorectal diseases: Current experience and future directions

Sylla

2010

WJGS

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“…In a porcine animal study, the navigation complexity of a hybrid endoscopic instrument during a NOTES peritoneoscopy with the well established transsigmoidal access [20] was compared with and without Endorientation. The endoscopic inertial measurement unit was fixed on the tip of a flexible endoscope ( fig.…”

Section: Clinical Evaluationmentioning

confidence: 99%

Endoscopic Orientation Correction

Höller

Penne

Schneider

et al. 2009

Medical Image Computing and Computer-Assisted Intervention – MICCAI 2009

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Abstract. An open problem in endoscopic surgery (especially with flexible endoscopes) is the absence of a stable horizon in endoscopic images. With our "Endorientation" approach image rotation correction, even in non-rigid endoscopic surgery (particularly NOTES), can be realized with a tiny MEMS tri-axial inertial sensor placed on the tip of an endoscope. It measures the impact of gravity on each of the three orthogonal accelerometer axes. After an initial calibration and filtering of these three values the rotation angle is estimated directly. Achievable repetition rate is above the usual endoscopic video frame rate of 30Hz; accuracy is about one degree. The image rotation is performed in real-time by digitally rotating the analog endoscopic video signal. Improvements and benefits have been evaluated in animal studies: Coordination of different instruments and estimation of tissue behavior regarding gravity related deformation and movement was rated to be much more intuitive with a stable horizon on endoscopic images.

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“…Solamente cuatro de las investigaciones revisadas se realizaron en humanos 24,27 y en todos los demás se utilizaron cerdos, con la excepción de uno, en el cual se utilizaron 4 perros junto a 6 cerdos 29,30,31,21 . , se reporta la realización de tres apendicectomías por vía transvaginal con la asistencia de un minilaparoscopio introducido a través del portal subumbilical y el neumoperitoneo fue confeccionado con la técnica cerrada.…”

Section: Características De Los Sujetos Estudiadosunclassified

“…Las rutas de accesos utilizadas en los estudios animales incluidos en esta revisión, incluyeron: boca, ano, uretra, seguida por la transgástrica, transcolónica, o transvesical respectivamente 18,[28][29][30][31] , solamente en algunos se hace mención al porcentaje de éxito y de complicaciones 18,28,[31][32][33][34][35][36][37][38][39][40][41] .…”

Section: Viscerotomía Por Notesunclassified

Cirugía endoscópica trans orificios naturales (NOTES)

O¹,

Useche

2009

Rev Chil Cir

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Systematic review of natural orifice transluminal endoscopy surgery (NOTES) for intrabdominal surgeryBackground: NOTES allows to perform entire traditional surgical procedures through a natural orifice. Aim: To evaluate models, techniques, outcomes, pitfalls, and applicability to the clinical setting of NOTES for intra abdominal surgery. Material and Methods: Systematic review of the literature. Studies were identified searching MEDLINE, EMBASE, CINAHL, Current Contents, Cochrane Library, Entrez PubMed, Clinical Trials Database from 2000 to 2008. Studies indentified in October 2008, were included if they were performed in live human subjects. Results: Of the studies included for review, most were experimental studies conducted in animals. Thus, the evidence base was very limited. Although intra-abdominal access could be achieved reliably via oral, anal, or urethral orifices, the optimal access route and method could not be established. Closure of viscerotomies could not be achieved reliably in all cases and the risk of peritoneal infection was not adequately evaluated. Although the majority of interventions could be performed in animals using NOTES, a number of technical problems were encountered that need to be resolved. Conclusions: NOTES is still in early stages of development and more robust technologies will be needed to achieve reliable closure and overcome technical challenges. Well-managed human studies need to be conducted to determine the safety and efficacy of NOTES in a clinical setting.

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An innovative, safe and sterile sigmoid access (ISSA) for NOTES

Abstract: The transcolonic approach using an innovative guide tube is feasible and safe. The technique described offers mentionable advantages and therefore reduces the known shortcomings of NOTES. However, further studies are needed to approve our results of an initial evaluation.

Cited by 129 publications

References 19 publications

NOTES in the management of colorectal diseases: Current experience and future directions

NOTES in the management of colorectal diseases: Current experience and future directions

Endoscopic Orientation Correction

Cirugía endoscópica trans orificios naturales (NOTES)

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