Natural orifice surgery: initial clinical experience

被引：133

作者：

Horgan, Santiago ^{[1
]}

Cullen, John P. ^{[1
]}

Talamini, Mark A. ^{[1
]}

Mintz, Yoav ^{[1
]}

Ferreres, Alberto ^{[2
]}

Jacobsen, Garth R. ^{[1
]}

Sandler, Bryan ^{[1
]}

Bosia, Julie ^{[1
]}

Savides, Thomas ^{[3
]}

Easter, David W. ^{[1
]}

Savu, Michelle K. ^{[1
]}

Ramamoorthy, Sonia L. ^{[1
]}

Whitcomb, Emily ^{[4
]}

Agarwal, Sanjay ^{[4
]}

Lukacz, Emily ^{[4
]}

Dominguez, Guillermo ^{[2
]}

Ferraina, Pedro ^{[2
]}

机构：

[1] Univ Calif San Diego, Dept Surg, San Diego, CA 92103 USA

[2] Buenos Aires Hosp Clin, Dept Gen Surg, Buenos Aires, DF, Argentina

[3] Univ Calif San Diego, Dept Gastroenterol, San Diego, CA 92103 USA

[4] Univ Calif San Diego, Dept Reprod Med, San Diego, CA 92103 USA

来源：

SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES | 2009年 / 23卷 / 07期

关键词：

Appendix; Cholecystectomy; Clinical papers; trials; research; Endoscopy; Surgical; TRANSLUMINAL ENDOSCOPIC SURGERY; ASSISTED VAGINAL HYSTERECTOMY; LAPAROSCOPIC HYSTERECTOMY; CHOLECYSTECTOMY; PERITONEOSCOPY; PATIENT;

D O I：

10.1007/s00464-009-0428-0

中图分类号：

R61 [外科手术学];

学科分类号：

摘要：

Background Natural orifice translumenal endoscopic surgery (NOTES) has moved quickly from preclinical investigation to clinical implementation. However, several major technical problems limit clinical NOTES including safe access, retraction and dissection of the gallbladder, and clipping of key structures. This study aimed to identify challenges and develop solutions for NOTES during the initial clinical experience. Methods Under an Institutional Review Board (IRB)-approved protocol, patients consented to a natural orifice operation for removal of either the gallbladder or the appendix via either the vagina or the stomach using a single umbilical trocar for safety and assistance. Results Nine transvaginal cholecystectomies, one transgastric appendectomy, and one transvaginal appendectomy have been completed to date. All but one patient were discharged on postoperative day 1 as per protocol. No complications occurred. Conclusion The limited initial evidence from this study demonstrates that NOTES is feasible and safe. The addition of an umbilical trocar is a bridge allowing safe performance of NOTES procedures until better instruments become available. The addition of a flexible long grasper through the vagina and a flexible operating platform through the stomach has enabled the performance of NOTES in a safe and easily reproducible manner. The use of a uterine manipulator has facilitated visualization of the cul de sac in women with a uterus to allow for safe transvaginal access.

引用

页码：1512 / 1518

页数：7

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