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

Satgunam, Shean; Miedema, Brent W.; Whang, Susan H.; Thaler, Klaus

doi:10.1007/s00464-012-2185-8

Cited by 7 publications

(2 citation statements)

References 23 publications

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“…7,18,102 Some authors have described manual straightening of endoscopic clips to mitigate this issue and facilitate placement, however, while successful, this technique is inefficient and not ideal given that it requires modifying a manufactured product. 18,95 Prototype flexible clip appliers capable of complete occlusion have been described 103 including one with a zero-gap clip. 97 Of note, clip placement using this prototype took 9 minutes, significantly longer than laparoscopic clip placement.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic-Assisted Transvaginal Cholecystectomy – the US Military Experience With Long-Term Follow Up

Judge,

Bandle,

Wang

et al. 2024

JSLS

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Objectives: We present our initial clinical experience applying Natural Orifice Transluminal Endoscopic Surgical (NOTES) technique to perform cholecystectomy in ten patients at a military institution.Methods: A posterior colpotomy was created to accommodate a single site working port used to facilitate dissection and gallbladder mobilization under direct visualization via an infraumbilical port. The specimen was retrieved through the vagina and the colpotomy was closed with absorbable suture under direct visualization. Long-term follow up was performed over the phone to assess quality of life with 2 widely used health-related quality of life (HRQoL) surveys including RAND-36 Health Item Survey (Version 1.0), 1 and the Female Sexual Function Index (FSFI). 2Results: Ten women underwent a laparoscopic-assisted transvaginal cholecystectomy (TVC) with 7 available for long-term follow-up. The average age was 28.9 years (20-37) and the indications for surgery included symptomatic cholelithiasis (9) and biliary dyskinesia (1). The mean operative time was 129 mins (95-180), and median blood loss was 34 ml (5-400). There were no conversions and the average length of stay was 9.98 hours (2.4-28.8). Pain (analogue scale 1-10) on postoperative day three was minimal (mean 2.3) and was limited to the infraumbilical incision. On average patients returned to work by postoperative day six and resumed normal daily activities at seven days. Immediate postoperative complications included one incident of postoperative urinary retention requiring bladder catheterization. One intra-operative cholangiogram was successfully performed due to elevated preoperative liver enzymes without significant findings. Long-term complications included one asymptomatic incisional hernia repair at the infraumbilical port site. The RAND-36 survey demonstrated an average physical and mental health summary score of 82.2 and 63.7 with an average general health score of 63.6. The average FSFI total score was 21.8. Conclusion:TVC is safe and effective. Implementation may improve operational readiness by returning service members to normal activities more expeditiously than conventional laparoscopy.

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Section: Discussionmentioning

confidence: 99%

Laparoscopic-Assisted Transvaginal Cholecystectomy – the US Military Experience With Long-Term Follow Up

Judge,

Bandle,

Wang

et al. 2024

JSLS

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“…In 2009, a new set of endoscopic instruments dedicated to NOTES, the generation 1 NOTES tool box (Ethicon Endo-Surgery Inc. (EES), Cincinnati, OH) was introduced. The tools were experimented in NOTES cholecystectomy procedures on porcine models [34, 35]. In spite of the encouraging results, these studies pointed out some limitations (such as visibility of the endoscopic clip applier tool tip) that can prevent this set of tools from being used successfully for humans.…”

Section: Discussionmentioning

confidence: 99%

Toward scar-free surgery: an analysis of the increasing complexity from laparoscopic surgery to NOTES

et al. 2014

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Background NOTES is an emerging technique for performing surgical procedures, such as cholecystectomy. Debate about its real benefit over the traditional laparoscopic technique is on-going. There have been several clinical studies comparing NOTES to conventional laparoscopic surgery. However, no work has been done to compare these techniques from a Human Factors perspective. This study presents a systematic analysis describing and comparing different existing NOTES methods to laparoscopic cholecystectomy. Methods Videos of endoscopic/laparoscopic views from fifteen live cholecystectomies were analyzed to conduct a detailed task analysis of the NOTES technique. A hierarchical task analysis of laparoscopic cholecystectomy and several hybrid transvaginal NOTES cholecystectomies was performed and validated by expert surgeons. To identify similarities and differences between these techniques, their hierarchical decomposition trees were compared. Finally, a timeline analysis was conducted to compare the steps and substeps. Results At least three variations of the NOTES technique were used for cholecystectomy. Differences between the observed techniques at the substep level of hierarchy and on the instruments being used were found. The timeline analysis showed an increase in time to perform some surgical steps and substeps in NOTES compared to laparoscopic cholecystectomy. Conclusion As pure NOTES is extremely difficult given the current state of development in instrumentation design, most surgeons utilize different hybrid methods – combination of endoscopic and laparoscopic instruments/optics. Results of our hierarchical task analysis yielded an identification of three different hybrid methods to perform cholecystectomy with significant variability amongst them. The varying degrees to which laparoscopic instruments are utilized to assist in NOTES methods appear to introduce different technical issues and additional tasks leading to an increase in the surgical time. The NOTES continuum of invasiveness is proposed here as a classification scheme for these methods, which was used to construct a clear roadmap for training and technology development.

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A state of the art review and categorization of multi-branched instruments for NOTES and SILS

et al. 2014

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

Cited by 7 publications

References 23 publications

Laparoscopic-Assisted Transvaginal Cholecystectomy – the US Military Experience With Long-Term Follow Up

Laparoscopic-Assisted Transvaginal Cholecystectomy – the US Military Experience With Long-Term Follow Up

Toward scar-free surgery: an analysis of the increasing complexity from laparoscopic surgery to NOTES

A state of the art review and categorization of multi-branched instruments for NOTES and SILS

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