Document Detail


Commentary on Complete transvaginal NOTES nephrectomy using magnetically anchored instrumentation Raman JD, Bergs RA, Fernandez R, Bagrodia A, Scott DJ, Tang SJ, Pearle MS, Cadeddu JA, Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX.
MedLine Citation:
PMID:  19414136     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
Evolution of minimally invasive techniques has prompted interest in natural orifice transluminal endoscopic surgery (NOTES). Challenges for NOTES include loss of instrument rigidity, reduction in working envelopes, and collision of instrumentation. Magnetic anchoring and guidance system (MAGS) is one surgical innovation developed at our institution whereby instruments that are deployed intra-abdominally are maneuvered by the use of an external magnet. We present our initial animal experience with complete transvaginal NOTES nephrectomy using MAGS technology. Transvaginal NOTES nephrectomy was performed in two female pigs through a vaginotomy, using a 40-cm dual-lumen rigid access port inserted into the peritoneal cavity. A MAGS camera and cauterizer were deployed through the port and manipulated across the peritoneal surface by way of magnetic coupling via an external magnet. A prototype 70-cm articulating laparoscopic grasper introduced through the vaginal access port facilitated dissection after deployment of the MAGS instruments. The renal artery and vein were stapled en-bloc using an extra-long articulating endovascular stapler. NOTES nephrectomies were successfully completed in both pigs without complications using MAGS instrumentation. The MAGS camera provided a conventional umbilical perspective of the kidney; the cauterizer, transvaginal grasper, and stapler preserved triangulation while avoiding instrument collisions. Operative duration for the 2 cases was 155 and 125 minutes, and blood loss was minimal. NOTES nephrectomy using MAGS instrumentation is feasible. We believe this approach improves shortcomings of previously reported NOTES nephrectomies in that triangulation, instrument fidelity, and visualization are preserved while hilar ligation is performed using a conventional stapler without need for additional transabdominal trocars.
Authors:
J Kyle Anderson
Related Documents :
18707736 - Retroperitoneal laparoscopic partial nephrectomy: surgical experience and outcomes.
18947636 - Retroperitoneal laparoscopic nephrectomy in children: at last the gold standard?
8732986 - Autologous adrenal medullary transplant in parkinson's disease: critical review of our ...
11984656 - Early small bowel obstruction complicating hand-assisted laparoscopic donor nephrectomy...
1956666 - Intra-abdominal use of the carbon dioxide laser for microsurgery.
11329576 - Primary peritoneal drainage for increasing ventilatory requirements in critically ill n...
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Urologic oncology     Volume:  27     ISSN:  1078-1439     ISO Abbreviation:  Urol. Oncol.     Publication Date:    2009 May-Jun
Date Detail:
Created Date:  2009-05-05     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9805460     Medline TA:  Urol Oncol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  344     Citation Subset:  IM    
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms
Descriptor/Qualifier:

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


Previous Document:  Commentary on Use of high fidelity operating room simulation to assess and teach communication, team...
Next Document:  1. Commentary on Feasibility study for image-guided kidney surgery: assessment of required intraoper...