An innovative, safe and sterile sigmoid access (ISSA) for NOTES.

Area of Science:

• Minimally Invasive Surgery
• Gastroenterology
• Surgical Innovation

Background:

• Transcolonic Natural Orifice Transluminal Endoscopic Surgery (NOTES) presents advantages over transgastric approaches.
• Existing NOTES techniques have limitations requiring resolution for human application.
• An innovative transcolonic method is presented as a potential advancement.

Purpose of the Study:

• To evaluate the feasibility and safety of a novel transcolonic approach for NOTES.
• To assess bacterial contamination associated with the transcolonic procedure.
• To determine the efficacy of surgical closure for the colonic entry site.

Main Methods:

• A specially designed guide tube was used for transcolonic access in porcine models.
• Procedures involved intraperitoneal decontamination and endoscopic abdominal evaluation.
• Surgical closure of the entry site was performed, with survival follow-up for 10 days.

Main Results:

• The transcolonic approach was completed without complications, including bleeding or organ injury.
• Surgical closure resulted in a leak-proof seal of the entry site.
• Survival model pigs exhibited excellent recovery, with well-healed colonic incisions and no signs of inflammation or abscesses.

Conclusions:

• The novel transcolonic NOTES approach using an innovative guide tube is feasible and safe.
• This technique offers significant advantages and mitigates known shortcomings of NOTES.
• Further research is necessary to validate these initial findings for broader application.