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Evaluation for transvaginal and transgastric NOTES cholecystectomy in human and animal natural orifice translumenal endoscopic surgery

  • Topics
  • Natural orifice translumenal endoscopic surgery (NOTES): innovation in HPB surgery
  • Published:
Journal of Hepato-Biliary-Pancreatic Surgery

Abstract

Background/purpose

Natural orifice translumenal endoscopic surgery (NOTES) is a novel concept using an endoscope via a translumenal access for abdominal surgery. This study was designed to evaluate the feasibility and technical aspects of NOTES cholecystectomy from our experience on humans and animals.

Methods

NOTES cholecystectomies were performed in 12 animal experiments, including 8 pigs (6 by transgastric and 2 by transvaginal accesses) and 4 dogs (4 transvaginal accesses), and a human female cadaver.

Results

The entire gallbladder could be removed under direct vision in all experiments. The average time was 60 min by transgastric and 40 min by transvaginal in animals. It was 87 min for human transvaginal cholecystectomy. In all animal and human procedures, there was no major complication concerning the operation.

Discussion

The transvaginal route may be the easiest route for abdominal NOTES. Percutaneous endoscopic gastrostomy (PEG) allowed the safe performance of a controlled gastric perforation and shortened the time. The hybrid method allowed performance of a safe procedure and shortened the time.

Conclusions

Transvaginal and transgastric NOTES cholecystectomy is technically feasible and safe in both humans and animals. New instrumentation needs to be developed to perform a pure NOTES cholecystectomy without transabdominal assistance.

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Acknowledgments

This study was partially supported by a Grant-in-Aid for Scientific Research from the Japan Society for the Promotion of Science, a JFE Grant from the Japanese Foundation for Research and Promotion of Endoscopy, and a Teikyo University Tomoko Fujii memorial research grant for young medical researchers.

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Correspondence to Maki Sugimoto.

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Sugimoto, M., Yasuda, H., Koda, K. et al. Evaluation for transvaginal and transgastric NOTES cholecystectomy in human and animal natural orifice translumenal endoscopic surgery. J Hepatobiliary Pancreat Surg 16, 255–260 (2009). https://doi.org/10.1007/s00534-009-0090-x

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  • DOI: https://doi.org/10.1007/s00534-009-0090-x

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