Department of Diagnostic and Interventional Endoscopy, Klinikum Suedstadt Rostock, Suedring 81, Rostock, Germany.
Endoscopy. 2012 Mar;44(3):265-9. doi: 10.1055/s-0031-1291546. Epub 2012 Feb 21.
The potential to use single-site transluminal access to perform major surgical procedures is limited. In the current study, a pure natural orifice transluminal endoscopic surgery (NOTES) technique was developed for sigmoid resection, with combined transgastric and transvaginal access to the abdominal cavity and assisted by colonoscopy.
This experimental study was conducted on a porcine model. Transgastric access was achieved by needle-knife incision and balloon dilation. Colonoscopy was used to maneuver the colon and expose the colic mesentery. Mesocolic dissection close to the bowel was carried out gastroscopically using a coagulating forceps. To prepare the anastomosis, a circular stapler anvil was introduced endoluminally. Subsequently, sigmoid resection was performed using a roticulating linear stapler inserted transvaginally. Bowel extraction was performed by invagination transrectally. After extracorporeal distal linear stapling of the sigmoid, colorectal anastomosis was completed by application of a circular stapling device transrectally. Gastric access closure was achieved using the over-the-scope clipping system (OTSC).
The procedure was successful in all animals, with the operation time ranging from 150 to 270 minutes. The first animal died at postoperative day 5 from peritonitis due to an infected hematoma following spleen injury by an observation trocar. All other animals gained weight postoperatively. Animals were sacrificed after postoperative day 35. The work-up showed complete anastomotic healing and healed gastric closure. The OTSC clip was still in situ in all animals.
The presented study shows that pure NOTES resection and anastomosis of the large bowel are feasible. Intraluminal organ manipulation provided excellent organ exposition and rendered one additional access site unnecessary. Transgastric preparation was shown to be safe and effective.
单部位经腔道入路进行主要外科手术的潜力有限。在本研究中，开发了一种纯经自然腔道内镜外科（NOTES）技术用于乙状结肠切除术，采用经胃和经阴道联合入路进入腹腔，并辅助结肠镜检查。
这项实验研究是在猪模型上进行的。经胃入路通过针刀切开和球囊扩张实现。结肠镜用于操作结肠并显露结肠系膜。使用电凝钳经胃进行接近肠管的系膜解剖。为了准备吻合，经腔内引入吻合器砧座。随后，经阴道插入旋转式线性吻合器进行乙状结肠切除。经直肠内翻出提取肠管。乙状结肠经体外远端直线吻合后，经直肠应用圆形吻合器完成结直肠吻合。经内镜用夹闭系统（OTSC）闭合胃入路。
所有动物的手术均成功完成，手术时间为 150 至 270 分钟。第一只动物术后第 5 天死于腹膜炎，原因是脾脏损伤的观察套管针引起的血肿感染。所有其他动物术后均体重增加。术后第 35 天处死动物。检查显示完全吻合愈合和愈合的胃闭合。所有动物的 OTSC 夹仍在位。
本研究表明，纯 NOTES 大肠切除和吻合是可行的。腔内器官操作提供了极好的器官显露，无需额外的入路。经胃准备是安全有效的。
