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10.183GS Natural Orifice Transluminal Endoscopic Surgery: A New Transvesical Technique in a...

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Published on Sep 17, 2010

TITLE: Natural Orifice Transluminal Endoscopic Surgery: A New Transvesical Technique in a Porcine Model

Objective: The optimal access route and method for NOTES has not been established. A transvesical approach is an effective clean portal of entry with its low rate of peritoneal contamination, but a safe urinary bladder closure has been a challenge. We developed a new technique for a safe, pure transvesical NOTES approach.

Methods: Four female piglets were used in the study. With the pigs under anesthesia, a flexible cystoscope (15Fr) was used to make an endoscopic cystotomy; diagnostic peritoneoscopy of the abdominal quadrants was done with biopsies and hemostasis. At the end, a Vicryl loop was pushed to close the bladder incision while the incision edges were pulled inwards. The pigs were euthanized after 2 weeks, and necropsies were performed.

Results: No bowel injury was noted in any of the 4 pigs. Satisfactory bladder closure was done in 2 pigs, while a partial closure was achieved in one case. In the postoperative period, none of the pigs showed any signs of pain or distress, voided normally, and had a good appetite. On necropsy, we noted no intraabdominal adhesions, healed cystotomy incision, and no adhesions at the site.

Conclusion: Our new technique for endoscopic cystotomy overcomes previously reported risks for bowel injuries. Using this route gives good spatial orientation and access to all quadrants including the pelvis. Biopsies with good hemostasis can be easily achieved. Endoscopic bladder closure by the described technique has not been previously reported. No postoperative intraperitoneal changes prove that this route is a safe and easy access that can be used in humans for similar procedures.

Authors: Jasneet Singh Bhullar, MD, Gokulakkrishna Subhas, MD, Aditya Gupta, Jonathan Cook, Michael J. Jacobs, MD, Boris Silberberg, MD, Lee Andrus, LVT, Melissa Decker, LVT, Vijay K. Mittal, MD, FACS

Department of Surgery, Providence Hospital and Medical Center, Southfield, Michigan, USA (Drs. Bhullar, Subhas, Gupta, Cook, Jacobs, Mittal).
Department of Patient Care Research, Providence Hospital and Medical Center, Southfield, Michigan, USA (Drs. Silberberg, Amdrus, Decker).

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