Abe Nobutsugu, Takeuchi Hirohisa, Ueki Hisayo, Matsuoka Hiroyoshi, Yanagida Osamu, Masaki Tadahiko, Mori Toshiyuki, Sugiyama Masanori, Atomi Yutaka
Department of Surgery, Kyorin University School of Medicine, Mitaka, Tokyo, Japan.
J Hepatobiliary Pancreat Surg. 2009;16(1):25-30. doi: 10.1007/s00534-008-0011-4. Epub 2008 Dec 17.
This experimental study was designed to assess the technical feasibility and benefits of our novel approach for transgastric NOTES (natural orifice translumenal endoscopic surgery) cholecystectomy.
Four pigs were subjected to NOTES cholecystectomy by the combined transgastric and transparietal approach using two flexible endoscopes. Under the guidance of a transparietal endoscope inserted through a trocar placed in the right upper abdomen, a gastrotomy was constructed, and a peroral endoscope was advanced into the peritoneal cavity through the gastrotomy and moved on retroflexion toward the gallbladder. Gallbladder excision with ligation of the cystic artery and duct using endoclips was performed using the peroral endoscope. After gastrotomy closure with endoclips inside the stomach, intraperitoneal lavage were carried out using the transparietal endoscope.
A complete gallbladder excision was carried out without major adverse events in all cases. The gastrotomies were successfully closed using endoclips (n = 3) or by the omentum-plug method (n = 1).
This approach is technically feasible and makes transgastric NOTES cholecystectomy easier and safer.
本实验研究旨在评估我们新颖的经胃NOTES（经自然腔道内镜手术）胆囊切除术方法的技术可行性和益处。
使用两个柔性内镜，通过经胃和经腹联合途径对4头猪实施NOTES胆囊切除术。在通过置于右上腹的套管针插入的经腹内镜引导下，构建胃切开术，经口内镜通过胃切开术进入腹腔，并在向后弯曲时朝向胆囊移动。使用经口内镜进行胆囊切除，并用内镜夹结扎胆囊动脉和胆囊管。在胃内用内镜夹关闭胃切开术后，使用经腹内镜进行腹腔灌洗。
所有病例均成功完成胆囊切除，无重大不良事件发生。胃切开术通过内镜夹（n = 3）或网膜填塞法（n = 1）成功关闭。
该方法在技术上是可行的，使经胃NOTES胆囊切除术更简便、更安全。
