Akça Oktay, Zargar Homayoun, Autorino Riccardo, Brandao Luis Felipe, Gürler Ahmet Selçuk, Avşar Abdullah, Horuz Rahim, Albayrak Selami
Department of Urology, Kartal Training and Research Hospital, İstanbul, Turkey.
Department of Urology, Glickman Urological and Kidney Institute, Cleveland, USA.
Turk J Urol. 2015 Jun;41(2):78-82. doi: 10.5152/tud.2015.40336.
To explore the feasibility of laparoscopic trans-rectal Natural Orifice Transluminal Endoscopic Surgery (NOTES) radical prostatectomy in a cadaveric model and to define anatomical landmarks of this surgical route.
After the ethical clearance, the study was conducted in Turkish Council of Forensic Medicine. With the cadaver in an exaggerated lithotomy position, a full thickness incision was made on the anterior wall of the rectum. The anteriorly visible Denonvilliers' fascia was incised sharply, exposing the posterior surface of the prostate. A single-port device (GelPOINT(®)Path) was inserted transanally passing the incision on the anterior wall of the rectum, into the bluntly created space between rectum and prostate. Three, 10 mm ports were placed through the GelPOINT(®)Path, at 3, 6, and 9 o'clock positions. A 5 mm, 0° degree lens was introduced at 6 o'clock position; followed by laparoscopic scissors and laparoscopic grasper. Prostatic and periprostatic anatomy was defined as encountered during each step of the procedure.
Exposure of the posterior surface of the prostate and seminal vesicles was easily achieved. No additional openings of the rectal wall were made. Surgical specimen was extracted keeping its integrity.
Transrectal radical prostatectomy is technically feasible in the cadaver model, being facilitated by previous experience with perineal surgery. Anatomical observations during the present experimental study suggest that the transrectal NOTES route provides good exposure of the operative field and easy access to the posterior surface of prostate, Future experimental endeavors should focus on reproducibility of this approach and feasibility of lymph node dissection using trans-rectal route.
探讨在尸体模型中进行腹腔镜经直肠自然腔道内镜手术（NOTES）根治性前列腺切除术的可行性，并确定该手术路径的解剖标志。
获得伦理批准后，在土耳其法医学委员会开展本研究。将尸体置于夸张的截石位，在直肠前壁做全层切口。锐性切开前方可见的狄氏筋膜，暴露前列腺后表面。经肛门将单孔装置（GelPOINT®Path）经直肠前壁切口插入，进入直肠与前列腺之间钝性分离出的间隙。通过GelPOINT®Path在3点、6点和9点位置放置3个10毫米的端口。在6点位置插入一个5毫米、0°的镜头，随后插入腹腔镜剪刀和腹腔镜抓钳。在手术的每个步骤中确定前列腺及前列腺周围的解剖结构。
很容易暴露前列腺和精囊的后表面。未额外切开直肠壁。完整地取出手术标本。
经直肠根治性前列腺切除术在尸体模型中技术上可行，既往会阴手术经验有助于该手术。本实验研究中的解剖学观察表明，经直肠NOTES路径能很好地暴露手术视野，便于进入前列腺后表面。未来的实验应着重于该方法的可重复性以及经直肠路径进行淋巴结清扫的可行性。
