Department of Scientific Direction, Minimally Invasive Surgery Centre Jesús Usón, Carretera N-521, km 41,8, 10071, Cáceres, Spain.
Surg Endosc. 2012 Apr;26(4):926-32. doi: 10.1007/s00464-011-1969-6. Epub 2011 Oct 20.
This study aims to evaluate the feasibility and usefulness of an ovine model in order to perform natural orifice translumenal endoscopic surgery (NOTES) approach and laparoscopic nephrectomy for research and training purposes.
Ten healthy female sheep were used to perform transvaginal NOTES-assisted right laparoscopic nephrectomy using a flexible 12-mm gastroscope through a vaginal access and two additional 5- and 10-mm trocars placed in the abdomen. The renal artery, the renal vein, and the ureter were dissected, and ligation was accomplished by using laparoscopic clips. The right kidney was retrieved transvaginally after enlarging the vaginal trocar incision. All data related with the surgical procedure, perioperative, and postoperative outcomes were recorded. The animals were monitored after surgery for a 30-day period with daily clinical follow-up.
We established a useful animal model of transvaginal NOTES-assisted laparoscopic nephrectomy, performing the transvaginal approach and the abdomen exploration with no complications in any animals. The renal artery, the renal vein, and the ureter were identified, clipped, and transected combining the 5-mm laparoscopic access and the endoscopic vision in the whole group. Mean operative time was 86 ± 14.49 min, estimated blood loss was less than 20 ml in all cases, and there was no bleeding or laceration of adjacent organs. The animals recovered successfully in all cases postoperatively. After 1 month, exploratory laparotomy did not show alterations in abdominal cavity, and the vaginotomy incision healed completely in every animal.
This experiment shows that transvaginal NOTES-assisted laparoscopic nephrectomy in ovine model is feasible and reproducible while offering an innovative possibility to help surgeons with this recent technology in the treatment of renal cancer. Well-managed experimental studies need to be carried out to determine the safety and efficacy of NOTES in the treatment of renal cancer.
本研究旨在评估绵羊模型在进行经自然腔道内镜外科（NOTES）入路腹腔镜肾切除术方面的可行性和实用性，以便进行研究和培训。
使用 10 只健康雌性绵羊，通过阴道入路和腹部另外放置的两个 5 毫米和 10 毫米 trocar，使用柔性 12 毫米胃镜进行经阴道 NOTES 辅助右侧腹腔镜肾切除术。解剖肾动静脉和输尿管，使用腹腔镜夹完成结扎。经阴道扩大阴道trocar切口后取出右侧肾脏。记录与手术过程、围手术期和术后结果相关的所有数据。手术后，所有动物在 30 天的时间内接受监测，每天进行临床随访。
我们成功建立了经阴道NOTES 辅助腹腔镜肾切除术的有用动物模型，所有动物均无并发症地完成了经阴道入路和腹部探查。在整个组中，通过 5 毫米腹腔镜入路和内镜视野，识别、夹闭和切断肾动静脉和输尿管。平均手术时间为 86 ± 14.49 分钟，所有病例估计出血量均小于 20 毫升，无出血或邻近器官损伤。所有动物术后均成功恢复。1 个月后，剖腹探查未发现腹腔改变，所有动物的阴道切开均完全愈合。
本实验表明，绵羊模型经阴道NOTES 辅助腹腔镜肾切除术是可行且可重复的，同时为外科医生提供了一种治疗肾癌的新技术的创新可能性。需要进行良好管理的实验研究，以确定NOTES 在治疗肾癌方面的安全性和有效性。
