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Comparative study of NOTES rectosigmoidectomy in a swine model: E-NOTES vs. P-NOTES.

D K Sohn1, S-Y Jeong, J W Park

  • 1Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea.

Endoscopy
|March 23, 2011
PubMed
Summary
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Embryonic natural-orifice transluminal endoscopic surgery (E-NOTES) rectosigmoidectomy is safe but challenging for pelvic dissection. Pure NOTES (P-NOTES) rectosigmoidectomy using transanal endoscopic microsurgery (TEM) shows promise for pelvic dissection but carries a higher risk.

Area of Science:

  • Minimally invasive surgery
  • Surgical innovation
  • Gastroenterology

Background:

  • Natural orifice transluminal endoscopic surgery (NOTES) offers potential for reduced invasiveness.
  • Previous studies suggest safety for pure NOTES (P-NOTES) and embryonic NOTES (E-NOTES).
  • Comparative safety and applicability of different NOTES approaches for rectosigmoidectomy require further investigation.

Purpose of the Study:

  • To compare the safety and applicability of E-NOTES versus P-NOTES rectosigmoidectomy.
  • To evaluate operative outcomes and complication rates between the two NOTES techniques.
  • To assess the feasibility of each approach in a swine model.

Main Methods:

  • Rectosigmoidectomy was performed using E-NOTES (laparoscopic, single port) and P-NOTES (TEM with transgastric assistance) in swine.

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  • Gastrotomies were created and closed using specific techniques; T-anchors were used for closure.
  • Systemic cytokine levels and operative outcomes were monitored; necropsy was performed one week post-procedure.

    • Main Results:

    • P-NOTES rectosigmoidectomy had a significantly longer operative time (239 vs. 103 minutes) and shorter anastomosis distance (2.9 vs. 17.6 cm) compared to E-NOTES.
    • P-NOTES showed a higher, though not statistically significant, complication rate (54.5% vs. 18.2%).
    • No significant differences were observed in systemic cytokine level changes (TNF-α, CRP, IL-6, IL-1β).

    Conclusions:

    • E-NOTES rectosigmoidectomy is safe in a swine model but presents challenges in pelvic dissection.
    • P-NOTES rectosigmoidectomy using TEM demonstrates potential for pelvic dissection.
    • The transgastric approach in P-NOTES is associated with a high degree of risk.