Transvaginal cholecystectomy without laparoscopic support using prototype flexible endoscopic instruments in a porcine model.

Surgical Endoscopy
Shean SatgunamKlaus Thaler

Abstract

Transvaginal cholecystectomy with laparoscopic assistance has been performed safely in humans. The next goal was to develop a natural orifice transluminal endoscopic surgery (NOTES) technique to perform cholecystectomy without laparoscopic instruments using one flexible endoscope and flexible accessories. The aim of the study was to test the feasibility of the procedure in a survival porcine model. Cholecystectomies were attempted in five 88-130-lb. pigs with a planned 2-week survival. Prototype flexible instruments (NOTES Toolbox, Ethicon Endo-Surgery, Inc.) were used to aid in access, dissection, and removal of the gallbladder via the transvaginal route. Cholecystectomy could be completed without abdominal incision using prototype instruments in four out of five pigs. The cystic duct could be exposed with a flexible hook knife and clips applied. The steerable trocar improved stability and the precision of the dissection. The critical view was established in all five pigs. Dissection of the gallbladder off the liver bed was imprecise resulting in gallbladder perforation in all pigs and liver hemorrhage in two. At necropsy, all clips on the cystic duct were secure and no bile leak, bowel injury, or adhesions were present. NOTES...Continue Reading

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Aug 3, 2010·Gastrointestinal Endoscopy·Susan H WhangKlaus Thaler

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Citations

Sep 25, 2014·Surgical Endoscopy·Ewout A ArkenboutPaul Breedveld
May 30, 2012·International Journal of Surgery·Baldwin Po Man Yeung, Terence Gourlay

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