Metzelder M, Vieten G, Gosemann J H, Ure B, Kuebler J F
Hannover Medical School, Department of Pediatric Surgery, Carl-Neuberg-Strasse 1, Hannover, Germany.
Eur J Pediatr Surg. 2009 Dec;19(6):362-5. doi: 10.1055/s-0029-1225358.
Recently, we showed that various procedures for rigid Natural Orifice Transluminal Endoscopic Surgery (NOTES) can be successfully performed in piglets. However, the safety and effectiveness of endoscopic closure of the urinary bladder remains to be determined before introducing transurethral NOTES in children. Our study was designed to investigate the safety and impermeability of the urinary bladder after endoscopic closure in transurethrally assisted nephrouretectomy in piglets.
Five female piglets (mean weight 14.5 kg; range: 14-15) underwent right-sided transurethral nephroureterectomy using a hybrid technique with one 15 mm trocar placed umbilically and one 3 mm trocar placed transvesically. Hilar dissection was performed with a 5 mm Endoligasure vessel sealing device. After umbilical retrieval of the resected kidney, the urinary bladder was closed by an Endoloop via an umbilical "two in one system" with the assistance of a 2 mm transurethrally placed endoscopic clamp. Endpoints of the study were total operation time, duration of cystoscopy and transurethral trocar positioning, duration of nephrectomy, duration of bladder closure and determination of bladder impermeability. Intraoperatively, bladder filling was performed with normal saline (ml), while bursting pressure (mmHg) was measured by filling the harvested bladder with air.
All nephroureterectomies were successfully performed with negligible blood loss. Mean total operation time was 46 min (range: 35-69). Cystoscopy and transurethral trocar positioning took 14 min (range: 9-23), and nephrectomy took 28 min (range: 18-48). Mean duration of bladder closure was 4 min (range: 2-6). Mean volume of intraoperative bladder filling was 94 ml (range: 80-100), indicating adequate capacity after closure with Endoloops. Post-mortem bladder impermeability was confirmed by a mean air filling bursting pressure of 88 mmHg (range: 70-140) indicating sufficient bladder closure.
A safe urinary bladder closure is mandatory for transurethral rigid NOTES procedures and can be adequately achieved with Endoloops.
最近，我们发现各种用于硬质经自然腔道内镜手术（NOTES）的操作在仔猪身上均可成功实施。然而，在将经尿道NOTES引入儿童之前，膀胱内镜闭合术的安全性和有效性仍有待确定。我们的研究旨在探讨仔猪经尿道辅助肾输尿管切除术中内镜闭合术后膀胱的安全性和不透性。
五只雌性仔猪（平均体重14.5千克；范围：14 - 15千克）接受了右侧经尿道肾输尿管切除术，采用混合技术，脐部放置一个15毫米套管针，经膀胱放置一个3毫米套管针。使用5毫米Endoligasure血管闭合装置进行肾蒂解剖。在经脐取出切除的肾脏后，通过Endoloop经脐“二合一系统”并借助经尿道放置的2毫米内镜夹闭合膀胱。研究终点包括总手术时间、膀胱镜检查和经尿道套管针定位时间、肾切除术时间、膀胱闭合时间以及膀胱不透性的测定。术中，用生理盐水（毫升）充盈膀胱，而通过向切除的膀胱内充入空气来测量破裂压力（毫米汞柱）。
所有肾输尿管切除术均成功完成，失血可忽略不计。平均总手术时间为46分钟（范围：35 - 69分钟）。膀胱镜检查和经尿道套管针定位耗时14分钟（范围：9 - 23分钟），肾切除术耗时28分钟（范围：18 - 48分钟）。膀胱闭合的平均时间为4分钟（范围：2 - 6分钟）。术中膀胱充盈的平均体积为94毫升（范围：80 - 100毫升），表明使用Endoloop闭合后膀胱容量充足。尸检证实膀胱不透性，平均空气充盈破裂压力为88毫米汞柱（范围：70 - 140毫米汞柱），表明膀胱闭合充分。
经尿道硬质NOTES手术必须安全闭合膀胱，使用Endoloop可充分实现这一目标。
