Transvaginal Natural Orifice Translumenal Endoscopic Surgery Cholecystectomy Early Evolution of the Technique
Transvaginal Natural Orifice Translumenal Endoscopic Surgery Cholecystectomy Early Evolution of the Technique
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DOI：
10.1097/sla.0b013e3181a802e2
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发表时间：
2009-06-01
影响因子：
9
通讯作者：
Bessler, Marc
中科院分区：
文献类型：
--
作者：
Gumbs, Andrew A.;Fowler, Dennis;Bessler, Marc
简介：自然孔腔内内窥镜手术（NOTES）最初的兴奋已经部分地被现实所缓和，即大多数团体尚未进行没有腹腔镜或针镜辅助的NOTES手术。在IACUC批准的空气猪模型中安全地进行腹腔镜辅助经阴道胆囊切除术后，我们开始了IRB批准的方案，最终进行纯粹的NOTES胆囊切除术。材料和方法：我们描述了在安全完成3次腹腔镜辅助后进行真正的NOTES经阴道胆囊切除术的经验人类混合NOTES手术。为了克服现有内窥镜的牵开限制，我们在第二和第三例患者中使用了5 mm弯曲或铰接牵开器，通过单独的阴道切开术将其置入腹部。在第四例患者中，气腹15 μ s，通过阴道套管针放置通过阴道切开术下直接的视觉和内窥镜放置的剪辑被用于胆囊管和动脉，从而避免了任何transabdominally放置的仪器或needle.Results的需要：这名患者是第一个病人接受完全NOTES胆囊切除术在我们的机构，我们在美国的知识。她出院的手术当天，并没有遭受任何并发症后1个月的follow-up.Conclusion：纯NOTES经阴道胆囊切除术没有援助的腹腔镜或针具是可行的，安全的人类。在与标准腹腔镜和混合技术进行比较研究之前，需要额外的经验。
Introduction: Initial excitement for Natural Orifice Transluminal Endoscopic Surgery (NOTES) has been partly tempered by the reality that a NOTES procedure without laparoscopic or needleoscopic-assistance has not been performed by most groups. After safely performing laparoscopically-assisted transvaginal cholecystectomy in air IACUC-approved porcine model, we embarked on an IRB-approved protocol to ultimately perform a pure NOTES cholecystectomy.Materials and Methods: We describe our experience with performing a true NOTES tansvaginal cholecystectomy after safely accomplishing 3 laparoscopically-assisted hybrid NOTES procedures in humans. To overcome the retracting limitations of currently available endoscopes, we used a 5-mm curved or articulating retractor that was placed into the abdomen via a separate colpotomy in the second and third patient. In a fourth patient, pneumoperitoneum to 15 torr was obtained via a transvaginal trocar placed through a colpotomy made under direct vision and endoscopically placed clips were used for both the cystic duct and artery, thus, obviating the need for any transabdominally placed instruments or needles.Results: This patient was the first patient to undergo a completely NOTES cholecystectomy at our institution and to our knowledge in the United States. She was discharged on the day of surgery and has not suffered any complication after 1 month of follow-up.Conclusion: Pure NOTES transvaginal cholecystectomy without aid of laparoscopic or needleoscopic instruments is feasible and safe in humans. Additional experience with this technique will be required before comparative studies to standard laparoscopy and hybrid techniques are appropriate.