NOTES transvaginal video-assisted cholecystectomy: first series

Ramos, Almino Cardoso; Murakami, Akihiro; Neto, Manoel Galvão; Galvao, Manoela; Silva, A C Souza; Canseco, Elvia; Moyses, Y

doi:10.1055/s-2008-1077398

Cited by 88 publications

(12 citation statements)

References 13 publications

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“…Since the first clinical descriptions of NOTES[1121314151617] there has been a concerted effort to refine the techniques of this exciting field because the potential benefits to patients are manifold. Despite the potential benefits of NOTES, to date there have not been any large studies demonstrating clear benefit over standard laparoscopy.…”

Section: Discussionmentioning

confidence: 99%

"Down-to-Up" transanal NOTES Total mesorectal excision for rectal cancer: Preliminary series of 9 patients

et al. 2014

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BACKGROUND:Applications for natural orifice translumenal endoscopic surgery (NOTES) to access the abdominal cavity have increased in recent years. Despite potential advantages of transanal and transcolonic NOTES for colorectal pathology, it has not been widely applied in the clinical setting. This study describes a series of nine patients for whom we performed transanal retrograde (“Down-to-Up”) total mesorectal excision for rectal cancer.MATERIALS AND METHODS:Under IRB approval, informed consent was obtained from each patient with rectal adenocarcinoma. Rectosigmoidectomy with total mesorectal excision was performed using low rectal translumenal access to the mesorectal fascia and subsequent dissection in a retrograde fashion. This was achieved using either a single port device or flexible colonoscope with endoscopic instrumentation and laparoscopic assistance. This was followed by transanal extraction of the specimen and hand-sewn anastomosis.RESULTS:Mean operative time was 311 min. Mean hospital stay was 7.56 days. Complications occurred in two patients, and consisted of one anastomotic leakage with reoperation and one intraoperative conversion to open surgery because of impossibility to dissect the specimen. TME specimen integrity was adequate in six patients.CONCLUSION:This series suggests that a retrograde mesorectal dissection via a NOTES technique is feasible in patients with rectal adenocarcinoma. This technique may act as a complimentary part of operative treatment for rectal cancer alongside other minimally invasive strategies. Long-term follow up will be needed to assess oncological results.

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Section: Discussionmentioning

confidence: 99%

"Down-to-Up" transanal NOTES Total mesorectal excision for rectal cancer: Preliminary series of 9 patients

et al. 2014

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“…Nevertheless, the most common and highlighted concern is about the lack of specific instruments dedicated to the vaginal access route [1–8]. Current procedures with commercially available flexible endoscopes are technically limited by the inability to manipulate tissue or retract organs [9].…”

Section: State Of the Artmentioning

confidence: 99%

“…On the contrary, a typical “transvaginally assisted laparoscopic cholecystectomy” is described by Ramos et al [8] who combined their experience with bariatric and laparoscopic surgery in order to avoid the lack of specific instrumentation for TVC. In details, in 32 patients the transvaginal route was used only to introduce a 10 mm 45° rigid bariatric laparoscopic optic through a 12 mm bariatric trocar placed in the posterior vaginal fornix.…”

Section: Hybrid Tvcmentioning

confidence: 99%

“…All the procedures were accomplished by using a single trocar of 5 mm placed in the left hypochondrium and not in the umbilical area to obtain a more ergonomic operative position to manipulate the gallbladder in combination with the transvaginal grasper, especially to fire clips. In contrast with authors who prefer standard rigid devices [8], these authors prefer using flexible endoscope to reach the supramesocolic region, so that the view of the biliary structures is facilitated by the flexibility of the endoscopic tips. However, endoscopes are not considered useful and safe for dissection, so this step is performed through the abdominal trocar, using, if necessary, the transvaginally inserted grasper only as a support for dissection in case of difficulties.…”

Section: Hybrid Tvcmentioning

confidence: 99%

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Update on Instrumentations for Cholecystectomies Performed via Transvaginal Route: State of the Art and Future Prospectives

Pulvirenti

Toro

Carlo

2010

Diagnostic and Therapeutic Endoscopy

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Natural Orifice Transluminal Endoscopic Surgery (NOTES) is an innovative approach in which a flexible endoscope enters the abdominal cavity via the transesophageal, transgastric, transcolonic, transvaginal or transvescical route, combining the technique of minimally invasive surgery with flexible endoscopy. Several groups have described different modifications by using flexible endoscopes with different levels of laparoscopic assistance. Transvaginal cholecystectomy (TVC) consists in accessing the abdominal cavity through a posterior colpotomy and using the vaginal incision as a visual or operative port. An increasing interest has arisen around the TVC; nevertheless, the most common and highlighted concern is about the lack of specific instruments dedicated to the vaginal access route. TVC should be distinguished between “pure”, in which the entire operation is performed through the transvaginal route, and “hybrid”, in which the colpotomy represents only a support to introduce instruments and the operation is performed mainly by the classic transabdominal-introduced instruments. Although this new technique seems very appealing for patients, on the other hand it is very challenging for the surgeon because of the difficulties related to the mode of access, the limited technology currently available and the risk of complications related to the organ utilized for access. In this brief review all the most recent advancements in the field of TVC's techniques and instrumentations are listed and discussed.

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“…The current instruments do not have the function or precision that is required to duplicate laparoscopic surgery. Some human NOTES cholecystectomies have been done, but most have been hybrid procedures with the assistance of laparoscopic instruments [11][12][13][14][15]. Techniques to eliminate the use of laparoscopic assistance in humans have involved using two endoscopes [16] or the passage of multiple transvaginal instruments [16,17].…”

Section: Introductionmentioning

confidence: 99%

Transvaginal cholecystectomy without laparoscopic support using prototype flexible endoscopic instruments in a porcine model

et al. 2012

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NOTES transvaginal video-assisted cholecystectomy: first series

Cited by 88 publications

References 13 publications

"Down-to-Up" transanal NOTES Total mesorectal excision for rectal cancer: Preliminary series of 9 patients

"Down-to-Up" transanal NOTES Total mesorectal excision for rectal cancer: Preliminary series of 9 patients

Update on Instrumentations for Cholecystectomies Performed via Transvaginal Route: State of the Art and Future Prospectives

Transvaginal cholecystectomy without laparoscopic support using prototype flexible endoscopic instruments in a porcine model

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