Crouzet Sebastien, Haber Georges-Pascal, Kamoi Kazumi, Berger Andre, Brethauer Stacy, Gatmaitan Patrick, Gill Inderbir S, Kaouk Jihad H
Section of Laparoscopic and Robotic Surgery, Glickman Urological Institute, The Cleveland Clinic Foundation, Cleveland, OH 44195, USA.
BJU Int. 2008 Dec;102(11):1715-8. doi: 10.1111/j.1464-410X.2008.07880.x. Epub 2008 Sep 3.
To present our laboratory experience with natural orifice translumenal endoscopic surgery (NOTES) renal cryoablation.
In two female farm pigs, we performed four procedures of NOTES renal cryoablation. In each pig, NOTES was performed through a transgastric approach and a transvaginal approach for each kidney, respectively. The pig was placed in the flank position and pneumoperitoneum obtained using a transabdominal Veress needle. In the first pig, we started with the left kidney with a transgastric approach: a dual-channel video gastroscope (Olympus, Tokyo, Japan) was used, the stomach wall was punctured using a needle-knife, a guidewire was passed into the abdominal cavity and the access dilated using a controlled radial expansion balloon. The bowel was mobilized medially and the Gerota's fascia overlying the upper pole was dissected. Under direct endoscopic vision, a cryoablation probe was introduced percutaneously into the anterior upper pole of the kidney. The pig was then flipped to the right flank position and a transvaginal approach was used: the gastroscope was introduced through the posterior fornix of the vagina. For the second pig, we performed initially a transgastric right-side cryoablation then a transvaginal left-side cryoablation as described for the first pig.
All four procedures were performed successfully, with no intraoperative complications. No additional laparoscopic ports or open conversions were necessary. The vision of the kidney and the ice-ball was adequate for all cases. The mean operative duration was 83 min. Stomach closure was tested watertight, and there were no abdominal or pelvic injuries found at autopsy.
NOTES can provide adequate minimal surgical dissection for safe and effective percutaneous renal cryoablation under direct videoscopic monitoring at kidney locations otherwise not accessible percutaneously. Both transgastric and transvaginal approaches can be used effectively for renal cryoablation providing a minimally invasive scar-less surgery.
介绍我们实验室开展经自然腔道内镜手术（NOTES）进行肾冷冻消融的经验。
在两只雌性农场猪身上，我们进行了4次NOTES肾冷冻消融手术。在每只猪身上，分别通过经胃途径和经阴道途径对每个肾脏进行手术。将猪置于侧卧位，使用经腹Veress针建立气腹。在第一只猪身上，我们先采用经胃途径处理左肾：使用双通道视频胃镜（日本东京奥林巴斯公司），用针刀穿刺胃壁，将导丝插入腹腔，并用可控径向扩张球囊扩张通道。将肠管向内侧游离，切开覆盖肾上极的肾周筋膜。在内镜直视下，经皮将冷冻消融探针插入肾上前极。然后将猪翻转至右侧卧位，采用经阴道途径：将胃镜经阴道后穹隆插入。对于第二只猪，我们先进行经胃途径的右侧冷冻消融，然后按照第一只猪的方法进行经阴道途径的左侧冷冻消融。
所有4次手术均成功完成，术中无并发症。无需额外的腹腔镜端口或转为开放手术。所有病例中肾脏及冰球的视野均良好。平均手术时间为83分钟。测试胃闭合处无渗漏，尸检未发现腹部或盆腔损伤。
NOTES能够在直视视频监测下，为在经皮无法到达的肾脏部位进行安全有效的经皮肾冷冻消融提供充分的最小限度手术分离。经胃途径和经阴道途径均可有效用于肾冷冻消融，实现微创无痕手术。
