Kim Taehyung, Sohn Dae Kyung, Park Ji Won, Park Chan-Ho, Moon Sang Hui, Chang Hee Jin, Kang Sung-Bum, Oh Jae Hwan
National Cancer Center, Goyang, Republic of Korea.
Surg Innov. 2013 Jun;20(3):225-9. doi: 10.1177/1553350612452345. Epub 2012 Jul 1.
Natural orifice transluminal endoscopic surgery (NOTES) and single access surgery are emerging techniques that reduce surgical invasiveness. This study was performed to evaluate the feasibility of NOTES transanal rectosigmoidectomy using a single port in a swine model.
Ten male pigs were used to conduct 2 studies, 4 for a nonsurvival study and 6 for a survival study. After anesthesia, the rectum was occluded transanally with a purse-string suture, and then a single port was placed. CO(2) gas was insufflated, and full-thickness rectal dissection was extended using laparoscopic instruments as far cephalad as possible. A 5-mm trocar was placed on the abdominal wall for transabdominal laparoscopic view, and then further colonic mobilization was performed using the endoscope through the anus. When the dissection was completed, the specimen was exteriorized and colorectal anastomosis was performed using a circular stapler. In the survival study, necropsies were performed on postoperative day 7.
Full-thickness circumferential rectosigmoid mobilization was achieved in all cases. The mean length of resected colon was 10 cm (range = 8-15 cm). No anastomotic defects were noted. All resected rectosigmoid specimens were grossly intact. No mortality or significant postoperative complications was observed in the survival group. On necropsy, a small abscess in the pelvic cavity was noted in 1 case and bladder distention was noted in 3 cases.
NOTES transanal rectosigmoidectomy using the single port is feasible and safe. Further experimental studies are warranted, especially in human cadaver model.
自然腔道内镜手术（NOTES）和单孔手术是新兴技术，可降低手术创伤性。本研究旨在评估在猪模型中使用单孔进行NOTES经肛门直肠乙状结肠切除术的可行性。
使用10只雄性猪进行2项研究，4只用于非存活研究，6只用于存活研究。麻醉后，经肛门用荷包缝合线封闭直肠，然后放置单孔。注入二氧化碳气体，使用腹腔镜器械尽可能向头侧扩大直肠全层解剖。在腹壁放置一个5毫米的套管针用于经腹腹腔镜观察，然后通过肛门使用内镜进一步游离结肠。解剖完成后，将标本取出，使用圆形吻合器进行结直肠吻合。在存活研究中，术后第7天进行尸检。
所有病例均实现了直肠乙状结肠全层环周游离。切除结肠的平均长度为10厘米（范围=8-15厘米）。未发现吻合口缺陷。所有切除的直肠乙状结肠标本大体完整。存活组未观察到死亡或明显的术后并发症。尸检时，1例发现盆腔有小脓肿，3例发现膀胱扩张。
使用单孔进行NOTES经肛门直肠乙状结肠切除术是可行且安全的。有必要进行进一步的实验研究，尤其是在人体尸体模型中。
