Document Detail


Complete transvaginal NOTES nephrectomy using magnetically anchored instrumentation.
MedLine Citation:
PMID:  19196056     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND AND PURPOSE: 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. MATERIALS AND METHODS: 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. RESULTS: 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 two cases was 155 and 125 minutes, and blood loss was minimal. CONCLUSIONS: 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:
Jay D Raman; Richard A Bergs; Raul Fernandez; Aditya Bagrodia; Daniel J Scott; Shou Jiang Tang; Margaret S Pearle; Jeffrey A Cadeddu
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of endourology / Endourological Society     Volume:  23     ISSN:  1557-900X     ISO Abbreviation:  J. Endourol.     Publication Date:  2009 Mar 
Date Detail:
Created Date:  2009-03-25     Completed Date:  2009-05-18     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8807503     Medline TA:  J Endourol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  367-71     Citation Subset:  IM    
Affiliation:
Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
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MeSH Terms
Descriptor/Qualifier:
Animals
Cautery
Endoscopy / methods*
Female
Magnetics / instrumentation*
Nephrectomy / methods*
Sus scrofa
Vagina / surgery*

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


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