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Snake charmer NOTES: a two-luminal access for hybrid NOS operations
Wolfram Lamadé1, Fabian Rieber, Peter Köhler
1Department of Surgery, Robert-Bosch-Krankenhaus, Stuttgart, Germany. wolfram.lamade@rbk.de
Summary
This study introduces a novel single-port sigmoidectomy technique using flexible colonoscopy for enhanced organ manipulation and visualization. This approach proved feasible and safe in a porcine model, facilitating effective colon surgery with minimal invasiveness.
Area of Science:
- Minimally Invasive Surgery
- Gastrointestinal Surgery
- Surgical Innovation
Background:
- Current minimally invasive techniques like NOTES, NOS, and SILS have limitations for extensive colon surgery.
- Colon surgery often necessitates multiple incisions or complex tools for retraction and triangulation.
- A need exists for simplified, effective single-port approaches in colon surgery.
Purpose of the Study:
- To present and evaluate a novel method for single-port colon surgery.
- To assess the feasibility and safety of single-port sigmoidectomy supported by flexible colonoscopy in a porcine model.
- To demonstrate the utility of flexible colonoscopy in enhancing surgical maneuverability and visualization during single-port procedures.
Main Methods:
- Single-port sigmoidectomy was performed on a porcine model.
- Flexible colonoscopy was employed for intraoperative organ manipulation, mesenteric exposure, and dissection.
- Specimen retrieval was achieved transrectally via invagination.
- Post-procedure assessment included autopsy at 21 days to evaluate anastomotic healing and complications.
Main Results:
- Single-port sigmoidectomy supported by colonoscopy was successfully performed in all five porcine cases.
- The technique provided a stable framework, superior organ guidance, and clear mesenteric exposition.
- Flexible colonoscopy allowed for dynamic adjustment of the surgical access angle, improving preparation and visualization.
- Autopsy revealed competent anastomotic healing with minimal adhesions; one case showed a small abscess with complete skin healing.
Conclusions:
- Single-port sigmoidectomy supported by flexible colonoscopy is a feasible and effective technique in a porcine model.
- This method overcomes limitations of current minimally invasive approaches by providing enhanced control and visualization.
- Flexible colonoscopy acts as a crucial tool, enabling precise dissection and adaptable surgical angles for complex procedures.
