Third-generation nephrectomy by natural orifice transluminal endoscopic surgery

被引:103
作者
Lima, Estevao
Rolanda, Carla
Pego, Jose M.
Henriques-Coelho, Tiago
Silva, David
Osorio, Luis
Moreira, Ivone
Carvalho, Jos L.
Correia-Pinto, Jorge
机构
[1] Univ Minho, Sch Hlth Sci, Life & Hlth Sci Res Inst, P-4719 Braga, Portugal
[2] S Marcos Hosp, Dept Gastroenterol & Anesthesiol, Braga, Portugal
[3] St Antonio Gen Hosp, Dept Urol, Oporto, Portugal
[4] Sra Oliveira Hosp, Dept Oncol, Guimaraes, Portugal
关键词
kidney; swine; nephrectomy; endoscopy; surgical procedures; minimally invasive;
D O I
10.1016/j.juro.2007.07.117
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 ; 100201 ;
摘要
Purpose: Recently there has been increasing enthusiasm for performing simple abdominal procedures by transgastric surgery. We previously reported the usefulness of a combined transgastric and transvesical approach to cholecystectomy. In this study we assessed the feasibility of combined transgastric and transvesical approach for performing a more complex surgical procedure, such as nephrectomy, in a porcine model. Materials and Methods: In a nonsurvival study combined transgastric and transvesical approaches were established in 6 female pigs. Under ureteroscope guidance we installed a transvesical 5 mm over tube into the peritoneal cavity and a flexible gastroscope was passed orally into the peritoneal cavity by a gastrotomy. We performed right or left nephrectomy with instruments introduced by the 2 devices that worked in the renal hilum, alternating device intervention for dissection and retraction procedures. Results: Four right and 2 left nephrectomies were performed. There were no complications during the creation of transvesical and transgastric access. In all animals we visualized the 2 kidneys. The renal vessels and ureter were reasonably individualized and ligated separately with ultrasonic scissors, which were introduced through the transvesical port. In 2 early cases mild hemorrhage occurred after ultrasonic ligation. To overcome this complication we applied clips successfully before ultrasonic ligation in the remaining animals. Thus, complete renal release and mobilization to the stomach were achieved in all animals. Conclusions: Nephrectomy by natural orifices using the combined transgastric and transvesical approach is technically feasible, although to our knowledge there is no reliable method for removing the specimen with current instruments.
引用
收藏
页码:2648 / 2654
页数:7
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