Wilhelm D, Meining A, von Delius S, Fiolka A, Can S, Hann von Weyhern C, Schneider A, Feussner H
Department of Surgery, Klinikum r. d. Isar, Technical University, Munich, Germany.
Endoscopy. 2007 May;39(5):401-6. doi: 10.1055/s-2007-966438.
The use of a transcolonic approach for natural orifice transluminal endoscopic surgery (NOTES) offers relevant advantages compared with a transgastric procedure. However both techniques are still limited by specific shortcomings that need to be resolved before the transluminal approach can be translated to human applications. In this article we describe an innovative method for a transcolonic procedure, which might represent the next step forward in NOTES.
In three acute and five survival porcine models we evaluated a specially designed guide tube, which is inserted via a transcolonic approach into the abdominal cavity after intraperitoneal instillation of a decontamination solution. After endoscopic evaluation of the abdomen the closure of the entry site was performed surgically. Main parameters obtained in the study were the feasibility and safety of the approach, the bacterial contamination due to the transcolonic procedure, and the safe closure of the entry site. Animals in the survival model were euthanized 10 days after the procedure.
The transcolonic approach took place without complications. There was no bleeding or laceration of adjacent organs. The surgical closure guaranteed a leak-proof closure of the entry site. All pigs in the survival model showed an excellent postinterventional course. At necropsy, the colonic incision sites were completely closed and appeared well healed. No abscesses or any sign of inflammation could be identified.
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.
与经胃手术相比，经结肠途径用于自然腔道内镜手术（NOTES）具有相关优势。然而，这两种技术仍受特定缺点的限制，在将经腔途径应用于人体之前，这些缺点需要得到解决。在本文中，我们描述了一种经结肠手术的创新方法，这可能代表了NOTES向前迈出的下一步。
在三个急性和五个存活猪模型中，我们评估了一种专门设计的导管，在腹腔内注入去污溶液后，通过经结肠途径将其插入腹腔。在内镜评估腹部后，通过手术关闭进入部位。本研究获得的主要参数是该途径的可行性和安全性、经结肠手术导致的细菌污染以及进入部位的安全关闭。存活模型中的动物在手术后10天实施安乐死。
经结肠途径手术无并发症发生。未出现出血或邻近器官的撕裂伤。手术缝合确保了进入部位的防漏闭合。存活模型中的所有猪术后恢复良好。尸检时，结肠切口部位完全闭合且愈合良好。未发现脓肿或任何炎症迹象。
使用创新导管的经结肠途径是可行且安全的。所描述的技术具有显著优势，因此减少了NOTES已知的缺点。然而，需要进一步研究来证实我们初步评估的结果。
