Metzelder Martin L, Vieten Gertrud, Gosemann Jan, Ure Benno, Kuebler Joachim F
Department of Pediatric Surgery, Hannover Medical School, Carl-Neuberg-Strasse 1, Hannover, Germany.
J Laparoendosc Adv Surg Tech A. 2009 Aug;19(4):581-7. doi: 10.1089/lap.2009.0105.
Natural orifice transluminal endoscopic surgery (NOTES) was introduced to reduce scars and the surgical trauma. The feasibility of this technique in children is unknown. Our study was designed to determine the feasibility of various procedures via a transurethral-assisted approach in an animal model.
Specially designed Aesculap-Braun (Tuttlingen, Germany) instruments and Endo-Ligasure (Valleylab, Boulder, CO) were used in 12 female piglets (mean weight, 15.2 kg; range, 14-17). A modified 12-mm device, including a 0-degree optic and a working channel, was used for the umbilical approach and for CO(2) insufflation (8 mm Hg, flow 5L/min). A 3-mm trocar, including a 2-mm optic, was introduced via the urethra and the urinary bladder dome into the abdominal cavity. The end-point of the study was the feasibility of nephroureterectomy (n = 8) and bilateral tuboovariectomy (n = 4).
All nephroureterectomies and bilateral tuboovariectomies were performed successfully. Closure of the urinary bladder was safely performed with Endoloops (Ethicon Endosurgery, Cincinnati, OH) via the umbilical "two in one system." Intracorporal suturing, knotting, and placement of Endoclips (Ethicon Endosurgery) during nephrectomy were time-consuming due to the restricted motion of the two in one system. The use of a vessel-sealing device allowed a safe, fast, and easy nephroureterectomy.
Modifications of instruments and approaches are mandatory for NOTES and must be tested in animal models before being used in infants and children. We showed that nephroureterectomy and tuboovariectomy can be performed safely via a transurethral and umbilical approach in female piglets. The use of vessel-sealing devices is essential in two in one systems with limited view and range of motion.
自然腔道内镜手术（NOTES）旨在减少瘢痕和手术创伤。该技术在儿童中的可行性尚不清楚。我们的研究旨在确定在动物模型中经尿道辅助途径进行各种手术的可行性。
使用专门设计的蛇牌-博朗（德国图特林根）器械和Endo-Ligasure（美国科罗拉多州博尔德市威力实验室）对12只雌性仔猪（平均体重15.2千克；范围14 - 17千克）进行手术。一种改良的12毫米装置，包括一个0度光学镜和一个工作通道，用于脐部入路和二氧化碳气腹（8毫米汞柱，流量5升/分钟）。一个3毫米的套管针，包括一个2毫米的光学镜，经尿道和膀胱穹隆插入腹腔。研究的终点是肾输尿管切除术（n = 8）和双侧输卵管卵巢切除术（n = 4）的可行性。
所有肾输尿管切除术和双侧输卵管卵巢切除术均成功完成。通过脐部“二合一系统”使用Endoloops（美国俄亥俄州辛辛那提市强生公司内镜手术部）安全地完成了膀胱闭合。由于二合一系统的活动受限，肾切除术中体内缝合、打结和放置Endoclips（强生公司内镜手术部）耗时较长。使用血管封闭装置可实现安全、快速且简便的肾输尿管切除术。
NOTES必须对器械和入路进行改良，并且在用于婴儿和儿童之前必须在动物模型中进行测试。我们表明，在雌性仔猪中，经尿道和脐部入路可以安全地进行肾输尿管切除术和输卵管卵巢切除术。在视野和活动范围有限的二合一系统中，使用血管封闭装置至关重要。
