Transgastric endoscopic splenectomy

Kantsevoy, Sergey V.; Hu, Bing; Jagannath, Sanjay; Vaughn, Cheryl A.; Beitler, Donna; Chung, Sydney S.C.; Cotton, Peter B.; Gostout, C. J.; Hawes, Robert H.; Pasricha, Pankaj J.; Magee, Carolyn; Pipitone, Laurie J.; Talamini, Mark A.; Kalloo, Anthony N.

doi:10.1007/s00464-005-0263-x

Cited by 284 publications

(153 citation statements)

References 17 publications

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“…[11][12][13][14][15][16][17] In fact, there are several theoretical advantages to NOTES. 1) There are no abdominal incisions and, therefore, abdominal wound infections and incisional hernias are avoided, possibly resulting in less pain and certainly in a better cosmetic effect.…”

Section: Discussionmentioning

confidence: 99%

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Third-Generation Nephrectomy by Natural Orifice Transluminal Endoscopic Surgery

et al. 2007

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Purpose:Recently there has been increasing enthusiasm for performing simple abdominal procedures by transgastric surgery. We previously reported the usefulness of a combined transgastric and transvesical approach to cholecystectomy. In this study we assessed the feasibility of combined transgastric and transvesical approach for performing a more complex surgical procedure, such as nephrectomy, in a porcine model. Materials and Methods: In a nonsurvival study combined transgastric and transvesical approaches were established in 6 female pigs. Under ureteroscope guidance we installed a transvesical 5 mm over tube into the peritoneal cavity and a flexible gastroscope was passed orally into the peritoneal cavity by a gastrotomy. We performed right or left nephrectomy with instruments introduced by the 2 devices that worked in the renal hilum, alternating device intervention for dissection and retraction procedures. Results: Four right and 2 left nephrectomies were performed. There were no complications during the creation of transvesical and transgastric access. In all animals we visualized the 2 kidneys. The renal vessels and ureter were reasonably individualized and ligated separately with ultrasonic scissors, which were introduced through the transvesical port. In 2 early cases mild hemorrhage occurred after ultrasonic ligation. To overcome this complication we applied clips successfully before ultrasonic ligation in the remaining animals. Thus, complete renal release and mobilization to the stomach were achieved in all animals. Conclusions: Nephrectomy by natural orifices using the combined transgastric and transvesical approach is technically feasible, although to our knowledge there is no reliable method for removing the specimen with current instruments.

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Section: Discussionmentioning

confidence: 99%

“…17 We chose to individualize each vessel, which we reasonably accomplished in the majority of cases, ligating them individually with ultrasonic scissors. Ultrasonic ligation was sufficient for most vessels but in 2 animals we observed mild hemorrhage after ultrasonic ligation.…”

Section: Discussionmentioning

confidence: 99%

Third-Generation Nephrectomy by Natural Orifice Transluminal Endoscopic Surgery

et al. 2007

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“…Several studies have since used the transgastric port for intraperitoneal abdominal procedures, such as fallopian tube ligation, cholecystectomy, gastrojejunostomy, lymphadenectomy, oophorectomy, partial hysterectomy, splenectomy, appendectomy, and diaphragmatic pacing [6][7][8][9][10][11][12][13][14][15]23]. Following the initial enthusiasm, however, abdominal procedures through isolated transgastric routes raised limitations that jeopardized application in humans.…”

Section: Experimental Studiesmentioning

confidence: 99%

“…These developments marked a new era in minimally invasive abdominal surgery, compelling novel, previously audacious goals, such as avoidance of incisions and pain. With the visceral wall no longer a barrier to endoscopic intervention, various authors described novel, complex abdominal procedures [6][7][8][9][10][11][12][13][14][15][16]. In 2006, such reports motivated researchers in this emerging field to organize the Natural Orifice Surgery Consortium for Assessment and Research (NOSCAR), a joint initiative supported by the American Society for Gastrointestinal Endoscopy (AGES) and the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES).…”

Section: Introductionmentioning

confidence: 99%

Transvesical endoscopic peritoneoscopy: Intra-abdominal scarless surgery for urologic applications

Lima¹,

Rolanda²,

Correia‐Pinto

2008

Curr Urol Rep

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For many abdominal procedures, advantages such as minimal scarring, reduced pain, and faster recovery have made laparoscopy the favored approach over traditional open surgery. The most recent minimally invasive approach is natural orifice transluminal endoscopic surgery (NOTES), which limits morbidity because this surgery does not require incision. This article reviews the history, development, and current and future applications of NOTES in the field of urology.

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“…In fact, Reddy and Rao (N. Reddy, V. G. Rao, oral communications, May 15 and 19, 2005; N. Reddy, oral communication, May 2004) and Kalloo et al [8] described a new port to the peritoneal cavity through a transgastric approach in humans and pigs, respectively. Subsequently, various authors described more-complex intra-abdominal procedures in porcine models, opening a new era in surgery that is being considered third generation surgery: the natural orifice translumenal endoscopic surgery (NOTES) [7,9,[11][12][13][14][19][20]. Building on these findings, our group described transvesical endoscopic peritoneoscopy as a complementary and safe approach to the abdominal cavity in a porcine model [10,16].…”

Section: Introductionmentioning

confidence: 99%

Transvesical thoracoscopy: A natural orifice translumenal endoscopic approach for thoracic surgery

et al. 2007

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Background: Recently there has been an increasing enthusiasm for using natural orifices translumenal endoscopic surgery (NOTES) to perform scarless abdominal procedures. We have previously reported the feasibility and safety of the transvesical endoscopic peritoneoscopy in a long-term survival porcine model as useful for those purposes. Herein, we report our successful experience performing transvesical and transdiaphragmatic endoscopic approach to the thoracic cavity in a long-term survival study in a porcine model. Methods: Transvesical and transdiaphragmatic endoscopic thoracoscopy was performed in six anesthetized female pigs. A 5 mm transvesical port was created on the bladder wall and an ureteroscope was advanced into the peritoneal cavity. After diaphragm inspection, we introduced through the left diaphragmatic dome a ureteroscope into the left thoracic cavity. In all animals, we performed thoracoscopy as well as peripheral lung biopsy. Animals were sacrificed by day 15 postoperatively. Results: We easily introduced a 9.8 Fr ureteroscope into the thoracic cavity that allowed us to visualize the pleural cavity and to perform simple surgical procedures such as lung biopsies without complications. There were neither respiratory distress episodes nor surgical complications to report. Postmortem examination revealed complete healing of vesical and diaphragmatic holes, whereas no signs of infection or adhesions were observed in the peritoneal or thoracic cavities. Conclusion: This study demonstrates the feasibility of transvesical thoracoscopy in porcine model. However, although this study extends the potential applications of NOTES to the thoracic cavity, new instruments and further work are needed to provide evidence that this could be translated to humans and with advantages for patients.

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Transgastric endoscopic splenectomy

Abstract: Transgastric endoscopic splenectomy in a porcine model appears technically feasible. Additional long-term survival experiments are planned.

Cited by 284 publications

References 17 publications

Third-Generation Nephrectomy by Natural Orifice Transluminal Endoscopic Surgery

Third-Generation Nephrectomy by Natural Orifice Transluminal Endoscopic Surgery

Transvesical endoscopic peritoneoscopy: Intra-abdominal scarless surgery for urologic applications

Transvesical thoracoscopy: A natural orifice translumenal endoscopic approach for thoracic surgery

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