Department of Surgery, Division of Urology, University of California, San Diego School of Medicine, La Jolla 92093, CA.
Urology. 2011 Mar;77(3):518-23. doi: 10.1016/j.urology.2010.10.057.
To examine feasibility of transrectal hybrid natural orifice translumenal endoscopic surgery (NOTES) nephrectomy in the porcine model. NOTES uses ports of entry to the peritoneal cavity instead of abdominal wall incisions, thereby eliminating visible scar and also potentially reducing postoperative pain.
After obtaining Institutional Animal Care and Use Committee approval, 3 female pigs (45 kg) underwent transrectal hybrid NOTES nephrectomy (2 right, 1 left). Pneumoperitoneum was created by a periumbilically-inserted 12-mm trocar, through which a laparoscope was advanced to obtain intraabdominal visualization. A horizontal incision was made 2 cm above the dentate line and a submucosal tunnel was created in the posterior rectal wall/presacral space. A dual-channel gastroscope was advanced through the submucosal tunnel and retroperitoneum to the level of the kidney using air insufflation. A window in the peritoneum was created and renal mobilization was completed. A transumbilically applied laparoscopic 45-mm stapler was used to transect the ureter and renal hilum. A specimen extraction bag was deployed transrectally and the specimen was delivered intact, followed by transrectal incision closure.
Transrectal hybrid NOTES nephrectomy was successfully performed in all cases. Mean operative time was 180 minutes (30 minutes for rectal access). Estimated blood loss was 50 mL. On necropsy, no intraabdominal injuries were noted.
In this initial report on feasibility of transrectal hybrid NOTES nephrectomy, we were able to perform the procedures with minimal blood loss and extract intact specimen. Survival studies are prerequisite to assess sterility and short- and long-term complications. This approach may be useful as an alternative to transvaginal access.
在猪模型中检验经直肠杂交自然腔道内镜手术（NOTES）肾切除术的可行性。NOTES 使用进入腹腔的端口而不是腹壁切口，从而消除了可见的疤痕，还可能减少术后疼痛。
在获得机构动物护理和使用委员会批准后，3 只雌性猪（45 公斤）接受了经直肠杂交NOTES 肾切除术（2 只右侧，1 只左侧）。通过脐部插入的 12mm 套管建立气腹，通过套管推进腹腔镜以获得腹腔内可视化。在齿状线以上 2cm 处做一个水平切口，并在后直肠壁/骶前空间创建一个黏膜下隧道。使用空气注入将双通道胃镜经黏膜下隧道和后腹膜推进至肾脏水平。在腹膜上创建一个窗口并完成肾脏游离。使用经脐应用的腹腔镜 45mm 吻合器横断输尿管和肾门。经直肠部署标本提取袋并完整递送标本，然后经直肠切口闭合。
所有病例均成功完成经直肠杂交NOTES 肾切除术。平均手术时间为 180 分钟（直肠进入时间 30 分钟）。估计失血量为 50 毫升。尸检时，未发现腹腔内损伤。
在经直肠杂交NOTES 肾切除术可行性的初步报告中，我们能够以最小的出血量进行手术，并提取完整的标本。生存研究是评估无菌性和短期及长期并发症的前提。这种方法可能作为经阴道进入的替代方法有用。
