Transanal endoscopic microsurgical platform for natural orifice surgery

Area of Science:

• Minimally Invasive Surgery
• Surgical Innovation
• Gastroenterology

Background:

• Natural Orifice Transluminal Endoscopic Surgery (NOTES) faces challenges in safe access and closure of transvisceral enterotomies.
• Current NOTES research often utilizes an oral transgastric approach.
• Transanal Endoscopic Microsurgery (TEM) is an established technique for rectal tumor resection and closure.

Purpose of the Study:

• To evaluate the feasibility of performing transrectal NOTES procedures using TEM instrumentation.

Main Methods:

• Standard TEM instruments and flexible endoscopes were employed in three porcine and three human cadaver models.
• Procedures included NOTES peritoneal access, peritoneoscopy, liver biopsy, and colorectal resections.

Main Results:

• Successful completion of true NOTES procedures utilizing TEM instrumentation was achieved.
• Demonstrated feasibility of transrectal NOTES for colorectal resection and anastomosis.

Conclusions:

• TEM instrumentation presents a viable portal for transrectal NOTES procedures.
• Challenges for clinical translation include TEM instrument design limitations, cost, and the learning curve for closure techniques.