Sugimoto Maki, Yasuda Hideki, Koda Keiji, Suzuki Masato, Yamazaki Masato, Tezuka Tohru, Kosugi Chihiro, Higuchi Ryota, Watayo Yoshihisa, Yagawa Yohsuke, Uemura Shuichiro, Tsuchiya Hironori, Hirano Atsushi, Ro Shoki
Department of Surgery, Teikyo University Chiba Medical Center, 3426-3 Anesaki, Ichihara, Chiba, 299-0111, Japan.
J Hepatobiliary Pancreat Surg. 2009;16(3):255-60. doi: 10.1007/s00534-009-0090-x. Epub 2009 Apr 10.
BACKGROUND/PURPOSE: Natural orifice translumenal endoscopic surgery (NOTES) is a novel concept using an endoscope via a translumenal access for abdominal surgery. This study was designed to evaluate the feasibility and technical aspects of NOTES cholecystectomy from our experience on humans and animals.
NOTES cholecystectomies were performed in 12 animal experiments, including 8 pigs (6 by transgastric and 2 by transvaginal accesses) and 4 dogs (4 transvaginal accesses), and a human female cadaver.
The entire gallbladder could be removed under direct vision in all experiments. The average time was 60 min by transgastric and 40 min by transvaginal in animals. It was 87 min for human transvaginal cholecystectomy. In all animal and human procedures, there was no major complication concerning the operation.
The transvaginal route may be the easiest route for abdominal NOTES. Percutaneous endoscopic gastrostomy (PEG) allowed the safe performance of a controlled gastric perforation and shortened the time. The hybrid method allowed performance of a safe procedure and shortened the time.
Transvaginal and transgastric NOTES cholecystectomy is technically feasible and safe in both humans and animals. New instrumentation needs to be developed to perform a pure NOTES cholecystectomy without transabdominal assistance.
背景/目的：经自然腔道内镜手术（NOTES）是一种通过经腔道途径使用内镜进行腹部手术的新概念。本研究旨在根据我们在人和动物身上的经验，评估NOTES胆囊切除术的可行性和技术要点。
在12项动物实验中进行了NOTES胆囊切除术，包括8头猪（6头经胃途径，2头经阴道途径）和4只狗（4头经阴道途径），以及1具女性人体尸体。
在所有实验中均能在直视下完整切除胆囊。动物实验中经胃途径平均用时60分钟，经阴道途径平均用时40分钟。人体经阴道胆囊切除术用时87分钟。在所有动物和人体手术中，均未出现与手术相关的严重并发症。
经阴道途径可能是腹部NOTES最简单的途径。经皮内镜下胃造口术（PEG）使可控性胃穿孔的操作安全可行，并缩短了手术时间。联合手术方法使手术安全进行并缩短了时间。
经阴道和经胃NOTES胆囊切除术在人和动物身上技术上均可行且安全。需要开发新的器械以在无腹部辅助的情况下完成单纯NOTES胆囊切除术。
