Minimally Invasive Surgery Program, Legacy Health, Portland, OR 97210, USA.
J Am Coll Surg. 2011 Sep;213(3):422-9. doi: 10.1016/j.jamcollsurg.2011.05.015.
Natural orifice endoscopic full-thickness colon resection attempts to overcome the need for invasive surgery in selected colorectal indications. Because basic technical requirements have not been met so far, the aim of this study was to develop a novel technique for endolumenal colon-wedge resection addressing current shortcomings.
Endoscopic full-thickness colon resection was attempted in a human cadaver model (n = 2), explanted porcine colon stumps (n = 10), and 3 acute pig models. A hypothesized colon lesion was created and retracted into an endoscopic clip closure system (ECCS). Initially used endoscopic graspers (n = 2) were replaced by a T-tag suture approach for retraction (n = 13). T-type anchors were deployed circumferentially to the lesion, which simultaneously marked resection margins. The clip was then applied for pre-resection tissue closure. The inverted tissue was excised by snare resection and was removed together with the sutures. Air leak-pressure of tissue closure was tested.
Endoscopic full-thickness colon resection was achieved in 14 of 15 attempts. The mean diameter (±SD) of resected animal specimen, including the predetermined margins, was 26 ± 4 mm. Using the T-tag sutures for retraction, the defined lesion was neither touched by an endoscopic grasper nor compromised by puncturing the center. Leak pressure tests revealed a significantly higher air pressure resistance of the pre-resection ECCS closure (61 ± 5 mmHg) compared with the hand-sewn control (26 ± 7 mmHg).
A novel endoscopic technique for full-thickness colon wall resection using tissue anchors for traction and an ECCS for pre-resection tissue closure appears to address several fundamental surgical principles. However, further studies are necessary before initial clinical application.
自然腔道内镜全层结肠切除术试图克服在选定的结直肠适应证中对侵入性手术的需求。由于基本技术要求尚未得到满足，因此本研究旨在开发一种新的内镜腔内结肠楔形切除术技术来解决当前的不足。
在人体尸体模型（n = 2）、离体猪结肠残端（n = 10）和 3 个急性猪模型中尝试进行内镜全层结肠切除术。假设创建了一个结肠病变并将其拉入内镜夹闭系统（ECCS）中。最初使用的内镜抓钳（n = 2）被 T 型缝线牵引方法（n = 13）所取代。T 型锚定器沿病变部位周围部署，同时标记切除边缘。然后应用夹子进行预切除组织闭合。通过圈套器切除翻转的组织，然后将其与缝线一起取出。测试组织闭合的气漏压力。
在 15 次尝试中有 14 次成功完成内镜全层结肠切除术。包括预定边缘在内的动物标本的平均直径（±SD）为 26 ± 4mm。使用 T 型缝线进行牵引时，预定病变既不会被内镜抓钳接触，也不会因刺穿中心而受损。泄漏压力测试显示，预切除 ECCS 闭合的空气压力阻力明显高于手工缝合对照（61 ± 5mmHg）（26 ± 7mmHg）。
一种新的使用组织锚进行牵引和 ECCS 进行预切除组织闭合的内镜全层结肠壁切除术技术似乎满足了几个基本的外科原则。然而，在初步临床应用之前，还需要进一步的研究。
