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Human NOTES cholecystectomy: transgastric hybrid technique.
Edward D Auyang1, Eric S Hungness, Khashayar Vaziri
1Department of Surgery, Northwestern University Feinberg School of Medicine, Galter 3-150, 251 E. Huron Street, Chicago, IL 60611-2908, USA.
Summary
Natural orifice transluminal endoscopic surgery (NOTES) hybrid transgastric cholecystectomy is a safe procedure in human patients. Further advancements in instrumentation are needed for pure NOTES transgastric cholecystectomy.
Area of Science:
- Minimally Invasive Surgery
- Endoscopic Surgery
Background:
- Natural orifice transluminal endoscopic surgery (NOTES) offers potential benefits like reduced pain and infection.
- Cholecystectomy is a common NOTES procedure, often performed transvaginally.
- Transgastric NOTES cholecystectomy shows feasibility in animal and human studies.
Purpose of the Study:
- To demonstrate the technique for transgastric NOTES hybrid cholecystectomy in human patients.
Main Methods:
- Patients with symptomatic gallstones underwent a diagnostic EGD.
- Peritoneal access was achieved via needle-knife cautery and balloon dilation under laparoscopic guidance.
- Endoscopic dissection, laparoscopic clipping, and laparoscopic over-sewing of the gastrotomy were performed.
Main Results:
- Four successful NOTES hybrid transgastric cholecystectomies were performed without operative complications.
Conclusions:
- Transgastric NOTES hybrid cholecystectomy is a safe procedure in humans.
- Current instrumentation presents technical challenges for pure NOTES.
- Development of safe access, retraction, and closure methods is crucial for pure NOTES transgastric cholecystectomy.