Liu Bing-Rong, Kong Ling-Jian, Song Ji-Tao, Liu Wei, Yu Heng, Dou Qin-Fa
Department of Gastroenterology and Hepatology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China.
J Laparoendosc Adv Surg Tech A. 2012 Oct;22(8):740-5. doi: 10.1089/lap.2012.0154. Epub 2012 Sep 12.
NOTES cholecystectomy has become one of the hottest areas of research. But most of the cases need the assistance of the laparoscope. This study is conducted to evaluate the feasibility and safety of a newly proposed operative method-functional cholecystectomy by pure NOTES.
The functional cholecystectomy was performed on eight female miniature pigs. An incision was made on the vaginal wall, and an endoscope was inserted into the peritoneal cavity to create a pneumoperitoneum to expose the intra-abdominal viscera, gallbladder, and cystic duct. The cystic duct was isolated and closed with a clip. Then, an injection needle was inserted into the gallbladder to suck up the bile. After the gallbladder was washed with saline, an incision was made on the wall of the gallbladder, and the tip of the endoscope was inserted into the gallbladder cavity. After the endoscope was withdrawn, the gallbladder incision was closed with clips in four pigs and was suspended in the other four pigs. The vaginal incision was closed with clips. All the animals were closely monitored and euthanized 28 days after the procedure. Necropsy was performed.
The functional cholecystectomy was successfully completed in all eight pigs. No severe intraoperative complications occurred. The animals recovered well postoperatively. At necropsy, no macroscopic signs of intraperitoneal infection or bile leakage in the peritoneal cavity were observed, and the clips were still present on the cystic duct in a good position in all cases. The gallbladder incision healed, with no sign of bile leakage or injury to the adjacent organs.
We successfully performed the functional cholecystectomy by transvaginal approach on pigs, which appears to be feasible, safe, and convenient. Functional cholecystectomy provides a new fitting path to pure NOTES.
经自然腔道内镜手术（NOTES）胆囊切除术已成为最热门的研究领域之一。但大多数病例需要腹腔镜辅助。本研究旨在评估一种新提出的手术方法——纯NOTES功能性胆囊切除术的可行性和安全性。
对8只雌性小型猪进行功能性胆囊切除术。在阴道壁做切口，插入内镜进入腹腔建立气腹，以暴露腹腔内脏器、胆囊和胆囊管。分离胆囊管并用夹子夹闭。然后，将注射针插入胆囊抽吸胆汁。用生理盐水冲洗胆囊后，在胆囊壁上做切口，将内镜尖端插入胆囊腔。内镜撤出后，4只猪的胆囊切口用夹子夹闭，另外4只猪的胆囊切口予以悬吊。阴道切口用夹子夹闭。术后对所有动物进行密切监测，并在术后28天实施安乐死。进行尸检。
8只猪均成功完成功能性胆囊切除术。术中未发生严重并发症。动物术后恢复良好。尸检时，未观察到腹腔内感染或胆汁漏出的宏观迹象，所有病例中胆囊管上的夹子位置良好。胆囊切口愈合，无胆汁漏出或邻近器官损伤的迹象。
我们成功地经阴道途径对猪实施了功能性胆囊切除术，该方法似乎可行、安全且便捷。功能性胆囊切除术为纯NOTES提供了一条新的合适途径。
