[Transgastric and transrectal hybrid NOTES cholecystectomy--experimental study]

Natural Orifice Transluminal Endoscopic Surgery (NOTES) is a dynamically developing branch of miniinvasive surgery, whose aim is a minimazing abdominal wall injury. Many experimental studies describe the wide spectrum of the NOTES techniques in the animal model. The NOTES experiment begun in the porcine model for acquiring experience at the Surgical Departement in the University Hospital in Hradec Králové.

Hybrid NOTES cholecystectomy with transgastric and transrectal approaches in the porcine model were performed there. Eight animals were operated and were observed for 7 to 14 days after operations. A post-operative morbidity and mortality was found as well as a post-mortal examination for intraperitoneal complications.

Three transgastric and five transrectal hybrid cholecystectomies were performed. One animal died immediately after operation due to an anaesthesiological complication. There were two transrectal operations that converted to open surgery due to massive rectum wall injury. Seven surviving animals were without complications in the post-operative period. No post-operative complication in post-mortal exploration were found, gastrotomy and colotomy were healed primarily, there were no signs for peritonitis.

The experimental study showed the posibility of futher continuing development of the hybrid NOTES technique in the porcine model, also its safety, pitfalls and complications were presented.