Department of Urology, Shiraz Nephrology Urology Research Center and Comparative Medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
J Endourol. 2009 Dec;23(12):1985-9. doi: 10.1089/end.2009.0255.
The aim of this study was to demonstrate the feasibility of hybrid natural orifice transluminal endoscopic surgery (NOTES) nephrectomy with standard laparoscopic instruments through a modified vaginal trocar in a canine model.
Ten cross-bred adult female dogs were used for right (n = 4) and left (n = 6) transvaginal nephrectomy. After transumbilical peritoneoscopy, a laparoscopic transvaginal trocar was introduced through the posterior vaginal fornix under direct vision. Using a 10-mm working laparoscope lens with a 3-mm working channel as endovision via the umbilical port and the transvaginal port, triangulation and dissection of the kidney and its hilum were performed. The renal artery and vein were closed with Hem-o-lok clips transvaginally. At the end of the procedure, after snaring the kidney in an endobag, the specimen was retrieved through a colpotomy incision by extending the vaginal port site.
All procedures were completed without need for conversion. The mean operative time was 101 minutes (75-135 minutes). The mean preoperative/postoperative hemoglobin was 12.01/11.7 g/dL and intraoperative blood loss was minimal. The mean size of the removed kidneys was 9.1 x 5.1 cm and the mean weight was 98.5 g (90-115 g). Exploration of the abdomen and vagina after 1 month showed complete healing of the colpotomy incision with no visceral injury. There were no significant adhesions or fibrotic changes in the renal fossa.
Hybrid NOTES nephrectomy is technically feasible in canine model with a standard laparoscopic setup and instruments. This study may remove barriers for further investigational work with NOTES technique, especially with a view to adapting it for use in low-resource centers, while offering a strategy to help surgeons train with this novel technology.
本研究旨在通过改良的阴道套管针，使用标准腹腔镜器械在犬模型中展示混合式经自然腔道内镜手术（NOTES）肾切除术的可行性。
10 只杂交成年雌性犬用于右侧（n = 4）和左侧（n = 6）经阴道肾切除术。经脐部腹腔镜检查后，直视下经后阴道穹窿引入腹腔镜经阴道套管针。使用带有 3mm 工作通道的 10mm 工作腹腔镜镜头作为经脐部和经阴道端口的内视镜，进行肾脏及其肾门的三角和解剖。经阴道用 Hem-o-lok 夹夹闭肾动静脉。手术结束时，将肾脏套入网兜后，通过阴道切口扩大套管针部位取出标本。
所有手术均无需中转开腹完成。平均手术时间为 101 分钟（75-135 分钟）。平均术前/术后血红蛋白为 12.01/11.7g/dL，术中出血量极少。切除肾脏的平均大小为 9.1x5.1cm，平均重量为 98.5g（90-115g）。术后 1 个月探查腹部和阴道，发现阴道套管针部位的切口完全愈合，无内脏损伤。肾窝无明显粘连或纤维性改变。
使用标准腹腔镜设备和器械，在犬模型中，混合式 NOTES 肾切除术在技术上是可行的。这项研究可能为进一步的 NOTES 技术研究消除障碍，特别是考虑到将其适应于资源有限的中心，同时为外科医生提供一种使用这种新技术进行培训的策略。
