Telem Dana A, Berger David L, Bordeianou Liliana G, Rattner David W, Sylla Patricia
Division of Gastrointestinal Surgery, Massachusetts General Hospital, 15 Parkman Street, Wang 460, Boston, MA 02114, USA.
Minim Invasive Surg. 2012;2012:287613. doi: 10.1155/2012/287613. Epub 2012 May 20.
The feasibility of natural orifice translumenal endoscopic surgery (NOTES) resection for rectal cancer has been demonstrated in both survival swine and fresh human cadaveric models. In preparation for transitioning to human application, our group has performed transanal NOTES rectal resection in a large series of human cadavers. This experience both solidified the feasibility of resection and allowed optimization of technique prior to clinical application. Improvement in specimen length and operative time was demonstrated with increased experience and newer platforms. This extensive laboratory experience has paved the way for successful clinical translation resulting in an ongoing clinical trial. To date, based on published reports, 4 human subjects have undergone successful hybrid transanal NOTES resection of rectal cancer. While promising, instrument limitations continue to hinder a pure transanal approach. Careful patient selection and continued development of new endoscopic and flexible-tip instruments are imperative prior to pure NOTES clinical application.
在存活猪和新鲜人体尸体模型中均已证明，经自然腔道内镜手术（NOTES）切除直肠癌具有可行性。为准备向人体应用过渡，我们团队在大量人体尸体上进行了经肛门NOTES直肠切除术。这一经验既巩固了切除的可行性，又在临床应用前优化了技术。随着经验的增加和采用更新的平台，标本长度和手术时间均有改善。这种广泛的实验室经验为成功的临床转化铺平了道路，促成了一项正在进行的临床试验。迄今为止，根据已发表的报告，已有4名受试者成功接受了经肛门NOTES直肠癌混合切除术。尽管前景乐观，但器械的局限性仍然阻碍着纯经肛门手术方法的实施。在NOTES临床纯应用之前，仔细选择患者并持续开发新的内镜和柔性尖端器械势在必行。
