| Transanal endoscopic microsurgical platform for natural orifice surgery. | |
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MedLine Citation:
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PMID: 18984102 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: The excitement surrounding natural orifice transluminal endoscopic surgery (NOTES) remains tempered by concerns over safe access and closure of transvisceral enterotomies. Research in NOTES has commonly been described as using an oral transgastric access point. Transanal endoscopic microsurgery (TEM) is a minimally invasive technique for a full-thickness resection of rectal tumors and with suture closure of the resultant defect with highly specialized instruments. This technique has been used clinically in human beings for more than 2 decades. Entry into the peritoneal cavity during a resection of rectosigmoid lesions has been described, and safe closure can be obtained. OBJECTIVE: To assess the feasibility of transrectal NOTES procedures by using TEM instrumentation. DESIGN: Three porcine and 3 human cadaver models were studied by using standard TEM instrumentation and flexible endoscopes. NOTES peritoneal access, a peritoneoscopy, a liver biopsy, and colorectal resections were performed. RESULTS: True NOTES procedures facilitated with TEM instrumentation were successfully completed. LIMITATIONS: This was a preclinical study, and several challenges to bridging to human clinical use exist: TEM instruments are currently designed for intraluminal tasks low in the pelvis, with 5-mm to 10-mm port sizes; the cost of the TEM instruments and insufflation system; and the learning curve to perform TEM closure. CONCLUSIONS: Our preclinical study demonstrated the feasibility of several transrectal NOTES procedures, colorectal resection, and anastomosis when using TEM instrumentation. We, therefore, suggest TEM as a portal for NOTES. |
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Authors:
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Peter M Denk; Lee L Swanström; Mark H Whiteford |
Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Gastrointestinal endoscopy Volume: 68 ISSN: 1097-6779 ISO Abbreviation: Gastrointest. Endosc. Publication Date: 2008 Nov |
Date Detail:
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Created Date: 2008-11-05 Completed Date: 2009-04-09 Revised Date: 2009-06-30 |
Medline Journal Info:
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Nlm Unique ID: 0010505 Medline TA: Gastrointest Endosc Country: United States |
Other Details:
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Languages: eng Pagination: 954-9 Citation Subset: IM |
Affiliation:
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Gastrointestinal and Minimally Invasive Surgery Division, Legacy Health System, The Oregon Clinic, PC, Portland, Oregon 97210, USA. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Anastomosis, Surgical Animals Biopsy / methods Cadaver Colectomy / methods Colon / surgery Feasibility Studies Humans Laparoscopy / methods Liver / pathology Microsurgery / methods Pneumoperitoneum, Artificial Proctoscopes Proctoscopy / methods* Rectum / surgery* Surgical Procedures, Minimally Invasive Surgical Stapling Sus scrofa |
| Comments/Corrections | |
Comment In:
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Gastrointest Endosc. 2009 Jul;70(1):193-4
[PMID:
19559847
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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