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

2012 ◽  
Vol 42 (7) ◽  
pp. 1237-1242 ◽  
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.

scholarly journals Natural Orifice Translumenal Endoscopic Surgery in Humans: A Review

2012 ◽  
Vol 2012 ◽  
pp. 1-8 ◽  
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.

FIRSTLY EXPERIENCE OF TRANSANAL AND TRANSVAGINAL NOTES FOR COLORECTAL CANCER

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

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

2020 ◽  
pp. 155335062093240
Author(s):  
Fabian Rössler ◽  
Andreas Keerl ◽  
Uwe Bieri ◽  
Juliette Slieker ◽  
Antonio Nocito
Keyword(s):  
Endoscopic Surgery ◽  
Special Focus ◽  
Complication Rates ◽  
Natural Orifice ◽  
Comprehensive Complication Index ◽  
Transvaginal Cholecystectomy ◽  
Gynecological Examination ◽  
Transvaginal Access ◽  
Standard Laparoscopic Cholecystectomy ◽  
Hybrid Notes

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.

scholarly journals Natural Orifice Transluminal Endoscopic Surgery

2009 ◽  
Vol 91 (6) ◽  
pp. 456-459 ◽  
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.

scholarly journals Robotics for Natural Orifice Transluminal Endoscopic Surgery: A Review

2012 ◽  
Vol 2012 ◽  
pp. 1-9 ◽  
Author(s):  
Xiaona Wang ◽  
Max Q.-H. Meng
Keyword(s):  
Laparoscopic Surgery ◽  
Postoperative Pain ◽  
Endoscopic Surgery ◽  
Surgical Procedure ◽  
State Of The Art ◽  
Abdominal Cavity ◽  
Natural Orifice ◽  
Robotic Platforms ◽  
Flexible Instruments ◽  
Natural Orifices

Natural Orifice Transluminal Endoscopic Surgery (NOTES) involves accessing the abdominal cavity via one of the bodies’ natural orifices, for example, mouth, anus, or vagina. This new surgical procedure is very appealing from patients’ perspectives because it eliminates completely abdominal wall aggression and promises to reduce postoperative pain, in addition to all other advantages brought by laparoscopic surgery. However, the constraints imposed by both the mode of access and the limited technology currently available make NOTES very challenging for the surgeons. Redesign of the instruments is imperative in order to make this emerging operative access safe and reproducible. In this paper, we survey on the state-of-the-art devices used in NOTES and introduce both the flexible instruments based on improvement of current endoscopic platforms and the revolutionary concept of robotic platforms based on the convergence of communication and micromechatronics technologies. The advantages and limitations of each category are addressed. Potential solutions are proposed to improve the existing designs and develop robust and stable robotic platforms for NOTES.

scholarly journals Surgical time and complications of total transvaginal (total-NOTES), single-port laparoscopic-assisted and conventional ovariohysterectomy in bitches

2015 ◽  
Vol 67 (3) ◽  
pp. 647-654 ◽  
Author(s):  
M.A.M. Silva ◽  
G.H. Toniollo ◽  
F.N. Flores ◽  
C.A.A. Valadão ◽  
R.M. Medeiros ◽  
...  
Keyword(s):  
Single Port ◽  
Abdominal Cavity ◽  
Postoperative Bleeding ◽  
Open Group ◽  
Surgical Time ◽  
The Right ◽  
Laparoscopic Assisted ◽  
Invasive Techniques ◽  
Ovarian Pedicle ◽  
Uterine Body

The recently developed minimally invasive techniques of ovariohysterectomy (OVH) have been studied in dogs in order to optimize their benefits and decrease risks to the patients. The purpose of this study was to compare surgical time, complications and technical difficulties of transvaginal total-NOTES, single-port laparoscopic-assisted and conventional OVH in bitches. Twelve bitches were submitted to total-NOTES (NOTES group), while 13 underwent single-port laparoscopic-assisted (SPLA group) and 15 were submitted to conventional OVH (OPEN group). Intra-operative period was divided into 7 stages: (1) access to abdominal cavity; (2) pneumoperitoneum; approach to the right (3) and left (4) ovarian pedicle and uterine body (5); (6) abdominal or vaginal synthesis, performed in 6 out of 12 patients of NOTES; (7) inoperative time. Overall and stages operative times, intra and postoperative complications and technical difficulties were compared among groups. Mean overall surgical time in NOTES (25.7±6.8 minutes) and SPLA (23.1±4.0 minutes) groups were shorter than in the OPEN group (34.0±6.4 minutes) (P<0.05). The intraoperative stage that required the longest time was the approach to the uterine body in the NOTES group and abdominal and cutaneous sutures in the OPEN group. There was no difference regarding the rates of complications. Major complications included postoperative bleeding requiring reoperation in a bitch in the OPEN group, while minor complications included mild vaginal discharge in four patients in the NOTES group and seroma in three bitches in the SPLA group. In conclusion, total-NOTES and SPLA OVH were less time-consuming then conventional OVH in bitches. All techniques presented complications, which were properly managed.

scholarly journals Description and Executability of a Novel Pre-tied Mini Ligature (Miniloop) in Laparocopic Ovariectomy in Cats

2017 ◽  
Vol 45 (1) ◽  
pp. 6
Author(s):  
Maria Eduarda Bastos Andrade Moutinho da Conceição ◽  
Renata Sitta Gomes Mariano ◽  
Roberta Martins Crivelaro ◽  
Felipe Faria Pereira da Câmara Barros ◽  
Marco Augusto Machado da Silva ◽  
...  
Keyword(s):  
Abdominal Cavity ◽  
Proximal Part ◽  
Contralateral Side ◽  
Surgical Instruments ◽  
Surgical Time ◽  
Access Port ◽  
Lateral Abdominal Wall ◽  
Gas Leakage ◽  
Surgical Access ◽  
Knot Pusher

Background: Ovariectomy(OVE) and ovariohysterectomy (OVH) are the most performed surgical procedures in Veterinary Medicine. In videosurgery, both in stray animals at sterilization campaigns and in the increasing demand of tutors to perform the technique. Laparoscopy results in reduced tissue damage, due to minimal organ manipulation and surgical access hemostasis can be performed by several methods, such as electro-coagulation, clips, and intra and extracorporeal ligatures. A pre-tied ligature system, or endoloop, is a haemostatic technique comprised of a slipknot and knot pusher, which is inserted into the abdominal cavity through one of the laparoscopic ports. The aim of this study was to describe a novel OVE technique in cats, in which haemostasis was performed using miniloop, aimed at reducing the number of ports needed for knot tying.Material, Methods & Results: Ten healthy not spayed female cats, aged 6 months to 5 years, were selected for this study. They were submitted to an OVE using miniloop as haemostasis method. Access to the peritoneal cavity was through two 5 mm ports on the midline of the ventral abdomen, 5 cm apart, with one immediately caudal to the umbilical scar and the other in between the last pair of teats. The first trocar was inserted at the caudal incision using the Hasson technique and a 5 mm zero-degree optics attached to a camera was introduced through it. The placement of the second access port was video assisted. For ovary exposure, the patients were positioned in lateral recumbency on the contralateral side to the ovary being removed. The miniloop was composed of a 2 mm diameter minitrocar, a 1.8 mm knot pusher, and a pre-tied slipknot. It was introduced percutaneously at the lateral abdominal wall. It was inserted attached to a pre-tied loop ligature. A Babcock forceps was used to guide the slipknot until it enveloped the ovarian vessels and the proximal part of the uterine horn. Subsequently, the knot was tightened with the aid of the knot pusher. A second miniligature was applied. The forceps was removed and a Metzenbaum scissors inserted to cut between the ligatures, releasing the ovary with the nylon ligature but keeping the PDS knot. It was performed at both ovary. Mean (±SD) surgical time was 44.8 min (± 13.4) and varied significantly (P = 0.0006) between animals, with the shortest time being 29 min and the longest 66 min. Positioning of the patients in lateral decubitus allowed for good ovarian exposure, without the need for excessive manipulation of the intestinal loops or other abdominal organs. Rupture of the suture thread was the only trans-operative complication observed and occurred in two animals. A second ligature (miniloop) was needed to ensure haemostasis. One cat showed eventration at the site of the caudal port on the second day post-operative.Discussion: The mean surgical time in the present study was lower than reported by some authors, but longer than anothers. Furthermore, the surgical time from this study is similar to that of other studies in cats in which haemostasis of the OAVC was achieved using bipolar electrocoagulation. Surgical team expertise is of outmost importance in minimizing complications and overcoming problems during videosurgical procedures in order to reduce surgical time, such as gas leakage, extensive incision, and difficulty in manipulating surgical instruments.

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

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.

Anesthetic Implications of Natural Orifice Translumenal Endoscopic Surgery (NOTES) and Single-Incision Laparoscopic Surgery (SILS)

2011 ◽  
pp. 175-178
Author(s):  
Kai Matthes
Keyword(s):  
Laparoscopic Surgery ◽  
Endoscopic Surgery ◽  
Abdominal Cavity ◽  
Academic Research ◽  
Surgical Techniques ◽  
Single Incision Laparoscopic Surgery ◽  
Natural Orifice ◽  
Less Invasive ◽  
Novel Technique ◽  
Laparoscopic Techniques

Chapter 18 discusses natural orifice translumenal endoscopic surgery (NOTES), which is currently investigated as an experimental alternative to diagnose and treat abdominal pathology combining endoscopic and laparoscopic techniques. Using a translumenal approach, the abdominal cavity is accessed with flexible endoscopes through an incision in the stomach, colon, or vagina. By obviating abdominal incisions, this approach may be less invasive than standard surgical techniques. This novel technique is currently performed at a few academic research institutions, but these less invasive operations potentially can be performed in an office-based setting in the future.

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