Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul 135-710, Korea.
Surg Endosc. 2011 Apr;25(4):1319-24. doi: 10.1007/s00464-010-1365-7. Epub 2010 Nov 3.
The clinical application of natural orifice transluminal endoscopic surgery (NOTES) for sigmoidectomy is associated with several difficulties that need to be overcome before wider clinical application of the procedure. The purpose of this study was to evaluate the technical feasibility and safety of transgastric sigmoidectomy in a survival animal model, as well as to evaluate the safety and usability of a custom paired magnetic intraluminal device, which we developed for the NOTES procedure.
Survival experiments were conducted on 24-33-kg dogs. After anesthesia, a gastrotomy was created using double-channel endoscope, and peritoneoscopy was performed. The sigmoid colon was retracted laterally using paired magnetic intraluminal device, the mesocolon was dissected, and the branch vessel was sealed. The anvil was placed into the descending colon through anus. A proximal and distal colonic transection was then performed. The circular stapler was passed through the anus and performed end-to-end anastomosis. Afterwards the specimen was removed through gastrotomy, and the gastric incision was closed. Postoperatively, all dogs were recovered and monitored for well-being during convalescence. Reexploration was practiced under anesthesia 2 weeks after surgery for evaluation of intra-abdominal complications, and intra-peritoneal cultures for microorganism.
The mean operative time was 141 (range, 122-157) min. There were no complications or physical evidence of sepsis or bowel obstruction during the observation period. Only one dog exhibited decreased body weight, decreasing to 20.4 kg from 22.4 kg after surgery; all of the other dogs exhibited increased body weight. We observed no evidence of peritonitis, intra-abdominal abscess, bleeding, or organ injury on reexploration conducted on day 14 after surgery.
Transgastric NOTES sigmoidectomy is a safe operation technique as evaluated in a dog model. The paired magnetic intraluminal device that was used in this study was useful to avoid an abdominal incision for retracting the sigmoid colon.
经自然腔道内镜外科（NOTES）行乙状结肠切除术的临床应用存在一些需要克服的难题，在此之前该术式难以广泛应用于临床。本研究旨在评估经胃NOTES 乙状结肠切除术在存活动物模型中的技术可行性和安全性，同时评估我们为 NOTES 手术开发的定制型配对磁腔内装置的安全性和实用性。
对 24-33kg 的犬进行存活实验。麻醉后，使用双通道内镜进行胃切开术，然后进行腹腔镜检查。使用配对磁腔内装置将乙状结肠侧向牵拉，游离系膜，结扎分支血管。将吻合器的钉砧经肛门放入降结肠。然后进行近端和远端结肠横断，经肛门将吻合器插入并完成端端吻合。之后通过胃切开术取出标本，并关闭胃切口。术后所有犬均恢复并在康复期监测其健康状况。术后 2 周，在麻醉下进行再次探查，评估腹腔内并发症和腹腔内微生物培养情况。
平均手术时间为 141（范围 122-157）min。观察期间无并发症，无感染或肠梗阻的临床或实验室证据。仅 1 只犬术后体重下降，从术前的 22.4kg 降至术后的 20.4kg；其他犬的体重均增加。术后 14 天再次探查时，未发现腹膜炎、腹腔脓肿、出血或器官损伤的证据。
在犬模型中，经胃 NOTES 乙状结肠切除术是一种安全的手术技术。本研究中使用的配对磁腔内装置有助于避免腹部切口以牵拉乙状结肠。
