| Survival study of natural orifice translumenal endoscopic surgery for rectosigmoid resection using transanal endoscopic microsurgery with or without transgastric endoscopic assistance in a swine model. | |
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MedLine Citation:
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PMID: 20174948 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: The feasibility of transanal rectosigmoid resection with transanal endoscopic microsurgery (TEM) was previously demonstrated in a swine nonsurvival model in which transgastric endoscopic assistance also was shown to extend the length of colon mobilized transanally. METHODS: A 2-week survival study evaluating transanal endoscopic rectosigmoid resection with stapled colorectal anastomosis was conducted with swine using the transanal approach alone (TEM group, n = 10) or a transanal approach combined with transgastric endoscopic assistance (TEM + TG group, n = 10). Gastrotomies were created using a needleknife and balloon dilation, then closed using prototype T-tags. Outcomes were evaluated and compared between the groups using Student's t-test and Fisher's exact test. RESULTS: Relative to the TEM group, the average length of rectosigmoid mobilized in the TEM + TG group was 15.6 versus 10.5 cm (p < 0.0005), the length of the resected specimen was 9 versus 6.2 cm (p < 0.0005), and the mean operative time was 254.5 versus 97.5 min (p < 0.0005). Intraoperatively, no organ injury or major bleeding was noted. Two T-tag misfires occurred during gastrotomy closure and four small staple line defects requiring transanal repair including one in the TEM group and three in the TEM + TG group (p = 0.2). Postoperatively, there was no mortality, and the animals gained an average of 3.4 lb. Two major complications (10%) were identified at necropsy in the TEM + TG group including an intraabdominal abscess and an abdominal wall hematoma related to T-tag misfire. Gastrotomy closure sites and colorectal anastomoses were all grossly healed, with adhesions noted in 60 and 70% and microabscesses in 50 and 20% of the gastrotomy sites and colorectal anastomoses, respectively. CONCLUSIONS: Natural orifice translumenal endoscopic surgery (NOTES) for rectosigmoid resection using TEM with or without transgastric endoscopic assistance is feasible and associated with low morbidity in a porcine survival model. Transgastric assistance significantly prolongs the operative time but extends the length of the rectosigmoid mobilized transanally, with a nonsignificant increase in complication rates related to gastrotomy creation. |
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Authors:
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Patricia Sylla; Dae Kyung Sohn; Sevdenur Cizginer; Yusuf Konuk; Brian G Turner; Denise W Gee; Field F Willingham; Maylee Hsu; Mari Mino-Kenudson; William R Brugge; David W Rattner |
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Publication Detail:
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Type: Comparative Study; Journal Article; Research Support, Non-U.S. Gov't Date: 2010-02-21 |
Journal Detail:
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Title: Surgical endoscopy Volume: 24 ISSN: 1432-2218 ISO Abbreviation: Surg Endosc Publication Date: 2010 Aug |
Date Detail:
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Created Date: 2010-07-02 Completed Date: 2010-11-02 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 8806653 Medline TA: Surg Endosc Country: Germany |
Other Details:
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Languages: eng Pagination: 2022-30 Citation Subset: IM |
Affiliation:
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Department of Surgery, Massachusetts General Hospital, Harvard Medical School, 15 Parkman Street, WACC 460, Boston, MA 02114, USA. psylla@partners.org |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Anal Canal Anastomosis, Surgical / methods Animals Colon, Sigmoid / surgery* Gastroscopy Male Microsurgery / methods* Models, Animal Proctoscopy / methods* Rectum / surgery* Survival Analysis Swine |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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