Department of Urology, Seoul National University Bundang Hospital, 166 Gumiro, Bundang-gu, Seongnam, Gyeonggi-do, 463-707, Korea.
Surg Endosc. 2012 Feb;26(2):558-64. doi: 10.1007/s00464-011-1905-9. Epub 2011 Oct 15.
Because of size limitation, the lack of reliable instruments, and bladder closure methods, transvesical natural orifice translumenal endoscopic surgery (NOTES) is still in its infancy. The porcine uterine horn is similar to the human vermiform appendix. Therefore, the resection of the porcine uterine horn is an established animal model for the human appendectomy. In this study, we evaluated the feasibility of a pure transvesical NOTES approach to uterine horn resection in a porcine model.
We performed five operations on three female pigs (30-35 kg) under general anesthesia in the Trendelenburg position. The laparoscope at the umbilicus was used only for the purpose of documentation. We used a rigid ureteroscope and a customized access system that prevented gas leakage and facilitated in-and-out passage of the instruments. A vesicostomy was created on the posterolateral bladder wall by using a needle knife through the channel of the ureteroscope. The uterine horn resection was performed by using an electric needle knife, hot forceps, and a polypectomy snare through the access system placed in vesicostomy. Bladder closure was performed with extracorporeal ties using metal clip tagged threads and a knot-pusher.
We successfully performed the pure transvesical NOTES uterine horn resections. The mean total operative time was 141.8 (± 58.7) min, and blood loss was minimal in all cases. No leakage was observed at the bladder repair sites after filling with normal saline. The removed uterine horns were approximately 6-12-cm long and 0.6-0.8 cm in diameter. On final inspection, the urethras were not damaged.
This study demonstrates the feasibility of a pure transvesical NOTES uterine horn resection in a porcine model. To the best of our knowledge, this is the world's first report on a pure transvesical NOTES with a therapeutic purpose. This study shows the potential for adoption of the transvesical approach in NOTES procedures.
由于尺寸限制、缺乏可靠的仪器以及膀胱闭合方法，经膀胱自然腔道内镜手术（NOTES）仍处于起步阶段。猪的子宫角类似于人类的阑尾。因此，猪的子宫角切除术是人类阑尾切除术的成熟动物模型。在本研究中，我们评估了在猪模型中采用纯经膀胱 NOTES 方法进行子宫角切除术的可行性。
在全身麻醉下，三头雌性猪（30-35 公斤）采用截石位，通过脐部腹腔镜仅用于记录目的。我们使用硬性输尿管镜和定制的进入系统，该系统可防止气体泄漏并方便器械进出。通过输尿管镜的通道，使用针状刀在膀胱后外侧壁上创建一个膀胱造口。通过放置在膀胱造口处的进入系统，使用电针、热钳和息肉切除术圈套器进行子宫角切除术。使用带有金属夹标记线和推结器的体外结扎线进行膀胱闭合。
我们成功完成了纯经膀胱 NOTES 子宫角切除术。平均总手术时间为 141.8（±58.7）分钟，所有病例出血量均很少。生理盐水填充后，膀胱修复部位未见渗漏。切除的子宫角长约 6-12 厘米，直径 0.6-0.8 厘米。最后检查时，尿道未受损。
本研究证明了在猪模型中采用纯经膀胱 NOTES 子宫角切除术的可行性。据我们所知，这是世界上首例具有治疗目的的纯经膀胱 NOTES 报道。本研究表明经膀胱入路在NOTES 手术中具有应用潜力。
