Natural Orifice Transluminal Endoscopic Surgery: Long-Term Experience with Hybrid Transvaginal Cholecystectomies

Objective. To assess outcome and safety of 571 hybrid natural orifice transluminal endoscopic surgery (NOTES) cholecystectomies. Methods. We retrospectively analyzed all consecutive NOTES cholecystectomies performed at our center between June 2009 and January 2018. All procedures were performed using a hybrid transvaginal technique, including an umbilical small-size trocar. End points, calculated at discharge, 30 and up to 90 days postoperatively, included intra- and postoperative morbidity assessed by the validated Clavien–Dindo classification and the Comprehensive Complication Index (CCI). Special focus was held on outcome and necessity of pre- and postoperative gynecological examinations. Results. We performed 571 hybrid NOTES cholecystectomies within 9 years. The vast majority were elective, 9.6% were emergency cholecystectomies. 6.7% of patients developed at least one complication until discharge, most of them minor (≤grade II). 30- and 90-day complication rates were 10.7% and 11%, respectively. Mean CCI at discharge and postoperative days 30 and 90 was 1.45 (±6.4), 2.3 (±7.7), and 2.4 (±7.8), respectively. Major complications (≥grade IIIa) occurred in 1.6% of patients, and 4 patients required emergency reoperation. No mortality was observed. In 9.8%, an additional abdominal trocar was placed. All patients underwent routine gynecological examination, whereof only 5 were rejected for transvaginal access preoperatively. In no case transvaginal access was discontinued intraoperatively due to gynecological disease. Conclusion. Hybrid NOTES transvaginal cholecystectomy represents a safe and feasible alternative to standard laparoscopic cholecystectomy. Preoperative gynecological examination is no longer routinely necessary, as intraoperative assessment is adequate.

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Natural Orifice Transluminal Endoscopic Surgery

Annals of The Royal College of Surgeons of England ◽

10.1308/003588409x464487 ◽

2009 ◽

Vol 91 (6) ◽

pp. 456-459 ◽

Cited By ~ 7

Author(s):

T Arulampalam ◽

S Paterson-Brown ◽

AJ Morris ◽

MC Parker

Keyword(s):

Clinical Research ◽

Endoscopic Surgery ◽

General Public ◽

Consensus Statement ◽

Medical Profession ◽

Current Status ◽

Natural Orifice ◽

Novel Method ◽

Hybrid Notes ◽

And Training

Natural orifice transluminal endoscopic surgery (NOTES) has generated healthy and vigorous debate about the introduction of an entirely novel method of surgical therapy. Although there are many reasons for scepticism, there is undoubted interest in this field from both the medical profession and general public. Those Associations currently involved in laparoscopic and endoscopic surgery wish to safeguard patients and the reputation of the profession by issuing clear guidance and support for those wishing to undertake NOTES. The purpose of this document is to review the current status of both NOTES and hybrid NOTES, while at the same time identifying obstacles in both clinical research and training. Furthermore, it aims to provide a consensus statement on behalf of the main UK specialty associations involved in this field of surgery. The primary aim of this consensus statement is to provide a framework within which to develop, safely and effectively, what must still be considered an experimental technique.

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Application of transanal extraction of specimen by laparoscopic surgery in treatment of rectal cancer

Vietnam Journal of Endolaparoscopic Surgery ◽

10.51199/vjsel.2019.1.3 ◽

2019 ◽

Vol 9 (1) ◽

Author(s):

Viết Hùng Trần ◽

Anh Vũ Phạm ◽

Anh Vũ Phạm

Keyword(s):

Rectal Cancer ◽

Laparoscopic Surgery ◽

Endoscopic Surgery ◽

Anterior Resection ◽

Rectal Adenocarcinoma ◽

Natural Orifice ◽

Natural Orifice Specimen Extraction ◽

Hybrid Notes ◽

Pull Through ◽

Transanal Extraction

Tóm tắt Đặt vấn đề: Phẫu thuật nội soi qua đường tự nhiên (NOTES: Natural orifice transluminal endoscopic surgery) và phẫu thuật nội soi truyền thống nhưng lấy bệnh phẩm qua ngả tự nhiên (Hybrid NOTES) là bước phát triển mới trong phẫu thuật ít xâm lấn điều trị ung thư đại trực tràng. Song nó vẫn chưa được phát triển rộng rãi trên thế giới cũng như ở Việt Nam. Nghiên cứu này nhằm mục đích đánh giá kết quả bước đầu phẫu thuật cắt ung thư trực tràng nội soi lấy bệnh phẩm qua đường tự nhiên. Phương pháp nghiên cứu: nghiên cứu tiến cứu. Đối tượng nghiên cứu gồm 32 người bệnh ung thư biểu mô tuyến trực tràng giai đoạn T≤3, N≤1, M0 được phẫu thuật từ 10/2012 đến 09/2015 tại BVTW Huế. Phương pháp nghiên cứu: phẫu thuật được tiến hành trên hai phương thức Hybrid NOTES(A) và NOTES(B) với ba kỹ thuật: cắt trước (AR: anterior resection), trước thấp (LAR: low anterior resection) và xuyên cơ thắt (Pull-through). Kết quả: Tất cả 32 người bệnh đều được phẫu thuật thành công cắt ung thư trực tràng nội soi lấy bệnh phẩm qua đường tự nhiên, không có trường hợp nào phải chuyển mổ mở. 3 trường hợp trong nhóm NOTES có tai biến chảy máu và thủng niệu đạo, phải đặt thêm trocar hỗ trợ và không có trường hợp nào tử vong. Thời gian phẫu thuật nhóm Hybrid NOTES là 194±47(120-280) phút, nhóm NOTES là 258±40(190-300) phút. Thời gian nằm viện: 9±2,7(4-19) ngày. Kết luận: Phẫu thuật cắt ung thư trực tràng nội soi lấy bệnh phẩm qua đường tự nhiên bước đầu cho thấy khả thi và an toàn trên cả hai phương thức: phẫu thuật nội soi đường bụng lấy bệnh phẩm qua ngả tự nhiên Hybrid NOTES và phẫu thuật hoàn toàn qua lỗ tự nhiên NOTES. Abstract Introduction: Transanal extraction of specimen by laparoscopic surgery for rectal cancer composed of Natural Orifice Transluminal Endoscopic Surgery (NOTES) and Hybrid NOTES nowadays is an important evaluation in minimally invasive for colorectal cancer surgery. However, it has not implemented commonly on over the world. This research is to evaluate the outcome of the technique in treatment of rectal cancer. Material and Methods: Prospective study was conducted from 10/2012 to 09/2015 in 32 patients diagnosed with rectal adenocarcinoma staging T≤3, N≤1, M0 and were operated using one of two modalities Hybrid NOTES (A) and NOTES (B) with three techniques: AR, LAR and Pull-through. Results: Thirty-two patients with rectal cancer were successfully operated by Hybrid NOTES and NOTES procedures. Three cases in group NOTES that had per-operative complications such as bleeding or urethra injury were required one or two additional trocars to complete the procedure, no conversion to open surgery and no mortality. The operation duration: group A (Hybrid NOTES): 194±47 (120-280) minutes; group B (NOTES): 258±40 (190-300) minutes. The length of hospital stay: 9±2.7 (4-19) days. Conclusion: Laparoscopic rectal resection with natural orifice specimen extraction for rectal cancer composed of Natural orifice transluminal endoscopic surgery (NOTES) and Hybrid NOTES is feasible and safe. However, a study in a large number of patient and long follow-up is necessary. Keyword: Natural orifice transluminal endoscopic surgery (NOTES), Hybrid NOTES, rectal cancer.

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Natural Orifice Translumenal Endoscopic Surgery in Humans: A Review

Minimally Invasive Surgery ◽

10.1155/2012/189296 ◽

2012 ◽

Vol 2012 ◽

pp. 1-8 ◽

Cited By ~ 9

Author(s):

Michelle P. Clark ◽

Emad S. Qayed ◽

David A. Kooby ◽

Shishir K. Maithel ◽

Field F. Willingham

Keyword(s):

Endoscopic Surgery ◽

Animal Studies ◽

Small Animal ◽

The United States ◽

Human Populations ◽

Natural Orifice ◽

Common Procedure ◽

Time Period ◽

Major Development ◽

Hybrid Notes

Natural orifice translumenal endoscopic surgery (NOTES) had its origins in numerous small animal studies primarily examining safety and feasibility. In human trials, safety and feasibility remain at the forefront; however, additional logistic, practical, and regulatory requirements must be addressed. The purpose of this paper is to evaluate and summarize published studies to date of NOTES in humans. The literature review was performed using PUBMED and MEDLINE databases. Articles published in human populations between 2007 and 2011 were evaluated. A review of this time period resulted in 48 studies describing procedures in 916 patients. Transcolonic and transvesicular procedures were excluded. The most common procedure was cholecystectomy (682, 75%). The most common approach was transvaginal (721, 79%). 424 procedures (46%) were pure NOTES and 491 (54%) were hybrid NOTES cases. 127 (14%) were performed in the United States of America and 789 (86%) were performed internationally. Since 2007, there has been major development in NOTES in human populations. A preponderance of published NOTES procedures were performed internationally. With further development, NOTES may make less invasive surgery available to a larger human population.

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Does a prior hysterectomy complicate transvaginal/transumbilical hybrid NOTES cholecystectomy?—a comparative analysis of prospectively collected data

Langenbeck s Archives of Surgery ◽

10.1007/s00423-021-02401-8 ◽

2021 ◽

Author(s):

Dirk R. Bulian ◽

Axel Sauerwald ◽

Panagiotis Thomaidis ◽

Claudia S. Seefeldt ◽

Dana C. Richards ◽

...

Keyword(s):

Urinary Bladder ◽

Length Of Stay ◽

Postoperative Complication ◽

Complication Rate ◽

Hospital Length Of Stay ◽

Complication Rates ◽

Comprehensive Complication Index ◽

Asa Classification ◽

Bladder Catheterization ◽

Hybrid Notes

Abstract Purpose Hysterectomy alters the anatomy of the posterior vaginal vault used as access for transvaginal/transumbilical hybrid NOTES cholecystectomy (NC), creating potential consequences for the feasibility and complication rate of the procedure. Therefore, the aim of our retrospective analysis of prospectively collected data was to analyze the postoperative course after NC in previously hysterectomized (PH) patients compared with patients who had not undergone hysterectomy (NH). Methods A total of 126 NH patients and 50 PH patients aged over 42 who had an NC from 12/2008 to 04/2021 were compared regarding age, body mass index (BMI), ASA classification, number of percutaneous trocars, need for intraoperative urinary bladder catheterization, length of procedure, conversion rate, and intraoperative and postoperative complication rate according to the Clavien/Dindo classification, Comprehensive Complication Index (CCI), mortality, and hospital length of stay. Results PH patients were older than NH patients (63.0 vs 51.5 years; P < 0.001) but did not differ significantly in ASA classification (P = 0.595) and BMI (26.8 vs 27.9 kg/m2; P = 0.480). They required more percutaneous trocars (P = 0.047) and longer procedure time (66.0 vs. 58.5 min; P = 0.039). Out of all 287 scheduled NC only one had to be “converted” to traditional laparoscopic cholecystectomy. Intraoperative and postoperative complication rates, Clavien/Dindo classification, CCI, need for intraoperative urinary bladder catheterization, and length of stay did not differ significantly. Conclusion Our results indicate an increased degree of difficulty of NC in PH patients, although there is no major impact on intraoperative and postoperative complication rates. Urinary bladder perforation is a specific access-related complication in PH patients.

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Transvaginal Laparoscopically-Assisted Endoscopic Appendectomy: A Major Hybrid Natural Orifice Transluminal Endoscopic Surgery Case Series in Asia

International Surgery ◽

10.9738/intsurg-d-16-00003.1 ◽

2016 ◽

Vol 101 (3-4) ◽

pp. 153-160 ◽

Cited By ~ 3

Author(s):

Abdul Qadir Khan ◽

Enyu Liu ◽

Weibo Niu ◽

Peng Li ◽

Hazrat Gul ◽

...

Keyword(s):

Postoperative Pain ◽

Laparoscopic Appendectomy ◽

Endoscopic Surgery ◽

Surgical Procedure ◽

Hybrid Approach ◽

Case Series ◽

Hybrid Technique ◽

Natural Orifice ◽

Conventional Laparoscopic ◽

Hybrid Notes

This paper represents an evaluation of a hybrid approach to natural orifice transluminal endoscopic surgery (NOTES) and its performance relative to conventional procedures. Globally, numerous institutions have successfully implemented minimally invasive surgeries by applying NOTES techniques and achieved decreased morbidity while performing incision-less surgery. However, these techniques are still not common in surgical practice in China and Pakistan. Documenting the experiences and challenges encountered in implementing NOTES in such environments can provide guidance for NOTES implementation elsewhere. From May 2010 to April 2012, 16 human transvaginal appendectomies were carried out applying a hybrid NOTES technique using a solo-umbilical trocar, which provided a safe access for laparoscopic assistance during surgical procedure. After removal of the appendix transvaginally, the colpotomy was sutured under direct vision with absorbable stitches. The outcomes of cases treated with hybrid NOTES techniques were compared to those of conventional laparoscopic appendectomy. All patients underwent a successful surgical procedure with no intra- or postoperative complications and provided no specific complaints during the 10th day and a monthly follow-up for 2 years. The patients convalesced promptly with healthy and satisfactory cosmetic results. Compared to conventional laparoscopic appendectomy, the hybrid NOTES operation had less postoperative pain, lower cost, and shorter hospitalization. Hybrid NOTES procedures can be performed safely using a solo-umbilical trocar. Our initial experience reveals that this hybrid technique is practically feasible and associated with minimal postoperative pain, reasonable convalescence time, and improved cosmetic outcomes.

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Natural Orifice Transluminal Endoscopic Surgery using the GelPOINT® V-Path Transvaginal Access Platform: An Early Experience

JAPANESE JOURNAL OF GYNECOLOGIC AND OBSTETRIC ENDOSCOPY ◽

10.5180/jsgoe.36.2_142 ◽

2020 ◽

Vol 36 (2) ◽

pp. 142-145

Author(s):

Hitomi Aoki ◽

Takaki Ishizuka ◽

Tomoko Sho ◽

Daisuke Nakajima ◽

Kazuaki Yoshimura

Keyword(s):

Endoscopic Surgery ◽

Early Experience ◽

Natural Orifice ◽

Transvaginal Access

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Natural Orifice Translumenal Endoscopic Surgery (NOTES) Transvaginal Cholecystectomy in a Morbidly Obese Patient

Obesity Surgery ◽

10.1007/s11695-008-9523-x ◽

2008 ◽

Vol 18 (7) ◽

pp. 886-889 ◽

Cited By ~ 48

Author(s):

Luis DeCarli ◽

Ricardo Zorron ◽

Alcides Branco ◽

Fernando Cirme Lima ◽

Marcos Tang ◽

...

Keyword(s):

Obese Patient ◽

Endoscopic Surgery ◽

Morbidly Obese ◽

Natural Orifice ◽

Transvaginal Cholecystectomy ◽

Morbidly Obese Patient

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FIRSTLY EXPERIENCE OF TRANSANAL AND TRANSVAGINAL NOTES FOR COLORECTAL CANCER

Journal of Medicine and Pharmacy ◽

10.34071/jmp.2017.4.11 ◽

2017 ◽

pp. 78-82

Author(s):

Nhu Hiep Pham

Keyword(s):

Colorectal Cancer ◽

Endoscopic Surgery ◽

Abdominal Cavity ◽

Colorectal Anastomosis ◽

Colon Adenocarcinoma ◽

Operation Time ◽

Natural Orifice ◽

Important Variation ◽

Hybrid Notes ◽

Post Radiation

Objective: Natural Orifice Transluminal Endoscopic Surgery (NOTES) is an important variation in minimally invasive surgery (MIS) nowaday. We would like to present the techniques and the results of the pure transanal and transvaginal laparoscopies (NOTES) in treatment of colorectal cancer. Material and method: Prospective study at Hue Central Hospital, Vietnam. Patients: From December 2013 to December 2015, 22 cololorectal cancers (17 rectum, 4 sigmoid tumors and 1 descending colon), adenocarcinoma, T≤ T3N1M0. Methods: The patients were placed in the lithotomy and Trendelenburg position, and the lone-star retractor was placed in anus (rectum cancer) or vagina (sigmoid cancer). Inflating of surgical cavity with CO2 and setting at 12 mmHg. Continuing dissection until go inside of the abdominal cavity (transanal technique), after that, the rectum was pushed into the abdominal cavity. The IMA, IMV were divided (TME included) in both techniques. After finishing dissection, specimens were pulled out through the anus or vagina to prepare anastomosis. The coloanal or colorectal anastomosis was performed by hand-sewn (6 cases) or by EEA staplers (16 cases). Results: 3 patients needed one more 5 mm umbilical port in RLQ, 1 patient needed two 5mm trocars (post radiation hemorrhagy, urethral perforation,…). 1 patient converted to open and 1 patient converted to HYBRID-NOTES procedure. The operation time was 258 ± 40 (190 - 300). All patients required minimal analgesia. Bowel movement returned on the first day in 16 patients (average: 2 days, maximum: 3 days). The hospital stay was 8 ± 2,6 (4 -14 days). Kirwan clasification (sphinter function) is very good (stage I: 16). Conclusions: Pure transanal and transvaginal laparoscopies in treatment of colorectal cancer are feasible and safe. It seems to be the first pure transvaginal laparoscopy (NOTES) for human in the world. However, a multicentric studies and long follow-up are necessary. Key words: Natural Orifice Transluminal Endoscopic Surgery (NOTES), colorectal cancer, Pure transanal

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Pure-transvaginal natural orifice transluminal endoscopic surgery (NOTES) ovariohysterectomy in bitches: a preliminary feasibility study

Ciência Rural ◽

10.1590/s0103-84782012005000050 ◽

2012 ◽

Vol 42 (7) ◽

pp. 1237-1242 ◽

Cited By ~ 4

Author(s):

Marco Augusto Machado Silva ◽

Gilson Hélio Toniollo ◽

Karym Christine de Freitas Cardoso ◽

Carolina Quarterone ◽

Maurício Veloso Brun

Keyword(s):

Endoscopic Surgery ◽

Abdominal Cavity ◽

Small Animal ◽

Natural Orifice ◽

Bipolar Diathermy ◽

Surgical Time ◽

Surgical Access ◽

Hybrid Notes ◽

Surgical Recovery ◽

Uterine Body

Natural orifice transluminal endoscopic surgery (NOTES) is a relatively new surgical access for minimally invasive surgery, which is being widely studied in human medicine. However, few studies focusing on its applicability in the small animal practice have been performed so far. The aim of the current study was to evaluate the feasibility of pure-NOTES transvaginal ovariohysterectomy in bitches. Five bitches were evaluated. The abdomen was accessed through an 11mm trocar inserted through a vaginal incision. Using a rigid endoscope with working channel, the ovarian pedicles were coagulated and sectioned using bipolar diathermy. The uterine horn was pulled into the trocar and exteriorized along with the cannula. The uterine body and vessels were coagulated or ligated. The uterine stump was replaced into the abdominal cavity and the pneumoperitoneum drained. Pure-NOTES OHE was successfully accomplished in four out of five bitches. In the first try, it was converted to a hybrid-NOTES technique due to instrument failure. Mean surgical time was 52.1 (SD±11.5 minutes) for the pure-NOTES technique. Pure-NOTES OHE is feasible in bitches, which may result in no major complications and excellent surgical recovery.

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