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Transvaginal cholecystectomy without laparoscopic support using prototype flexible endoscopic instruments in a
Shean Satgunam1, Brent Miedema, Susan Whang
1Department of Surgery, University of Missouri, One Hospital Drive, Columbia, MO 65212, USA.
Surgical Endoscopy
|February 25, 2012
Summary
Natural orifice transluminal endoscopic surgery (NOTES) cholecystectomy is feasible in pigs using flexible instruments. While controlling the cystic duct was successful, gallbladder dissection challenges require further instrument development for human application.
Area of Science:
- Minimally invasive surgery
- Gastroenterology
- Surgical innovation
Background:
- Transvaginal cholecystectomy with laparoscopic assistance is established.
- The study aimed to develop a pure natural orifice transluminal endoscopic surgery (NOTES) cholecystectomy technique.
- The goal was to perform cholecystectomy using only a flexible endoscope and accessories, without laparoscopic instruments.
Purpose of the Study:
- To assess the feasibility of a pure NOTES cholecystectomy technique.
- To evaluate prototype flexible endoscopic instruments for gallbladder removal.
- To test the procedure in a survival porcine model.
Main Methods:
- Cholecystectomies were performed in five pigs using prototype flexible instruments (NOTES Toolbox).
- Transvaginal access was utilized for gallbladder dissection and removal.
- A planned 2-week survival period was implemented.
Main Results:
- Cholecystectomy was completed without abdominal incision in four out of five pigs.
- Prototype instruments allowed for cystic duct exposure and clipping.
- Despite successful duct control, gallbladder dissection led to perforation in all pigs and hemorrhage in two.
Conclusions:
- Pure NOTES cholecystectomy is feasible but technically challenging with current flexible endoscopic devices.
- Prototype clip appliers effectively controlled the cystic duct.
- Instrument design improvements are necessary for enhanced precision and safety in pure NOTES procedures.
