Natural orifice transluminal endoscopic wedge hepatic resection with a water-jet hybrid knife in a non-survival porcine model.
Natural orifice transluminal endoscopic wedge hepatic resection with a water-jet hybrid knife in a non-survival porcine model.
复制标题
在非存活猪模型中使用水射流混合刀进行自然孔腔内窥镜楔形肝切除术。
DOI：
10.3748/wjg.v17.i7.926
复制
发表时间：
2011
影响因子：
4.3
通讯作者：
Yong
中科院分区：
文献类型：
--
作者：
H. Shi;Sheng;Bin Li;Deng;Pei Xin;Yong
目的
探讨水射流混合刀在非存活猪模型中使用自然孔腔内窥镜手术 (NOTES) 方法促进楔形肝切除的可行性。
方法
Erbe Jet2 水射流系统允许在预先选定的压力下进行无针、组织选择性水力解剖。使用该系统，在全身麻醉下，通过三种自然途径（经肛门、经阴道和经脐）对三头重 35 公斤的母猪进行楔形肝切除术。使用钩刀通过 15 毫米切口进入腹膜腔。用 APC 探针标记目标肝段，然后使用喷水混合刀进行楔形肝切除，并借助安装在内窥镜尖端的 4 毫米透明距离软帽来支撑所需平面。用 Endoclips 夹住暴露的血管和导管结构。通过电灼对肝实质出血切边进行止血。手术后，切口部位保持开放，对动物实施安乐死，然后进行尸检。
结果
使用 Erbe Jet2 水射流系统，在没有腹腔镜辅助的情况下，成功对两只猪进行了经肛门和经阴道楔形肝切除术。由于操作平台不稳定，经脐尝试失败。进入腹膜的切口需要1分钟，切除肝组织需要大约2小时。术中失血量为100至250毫升。在显微镜下，水解剖相对精确且温和，保留了大多数血管。
结论
Erbe Jet2水刀系统可以在NOTES中安全地完成非解剖楔形肝切除，值得进一步研究以缩短解剖时间。
AIM
To explore the feasibility of a water-jet hybrid knife to facilitate wedge hepatic resection using a natural orifice transluminal endoscopic surgery (NOTES) approach in a non-survival porcine model.
METHODS
The Erbe Jet2 water-jet system allows a needleless, tissue-selective hydro-dissection with a pre-selected pressure. Using this system, wedge hepatic resection was performed through three natural routes (trans-anal, trans-vaginal and trans-umbilical) in three female pigs weighing 35 kg under general anesthesia. Entry into the peritoneal cavity was via a 15-mm incision using a hook knife. The targeted liver segment was marked by an APC probe, followed by wedge hepatic resection performed using a water-jet hybrid knife with the aid of a 4-mm transparent distance soft cap mounted onto the tip of the endoscope for holding up the desired plane. The exposed vascular and ductal structures were clipped with Endoclips. Hemostasis was applied to the bleeding cut edges of the liver parenchyma by electrocautery. After the procedure, the incision site was left open, and the animal was euthanized followed by necropsy.
RESULTS
Using the Erbe Jet2 water-jet system, trans-anal and trans-vaginal wedge hepatic resection was successfully performed in two pigs without laparoscopic assistance. Trans-umbilical attempt failed due to an unstable operating platform. The incision for peritoneal entry took 1 min, and about 2 h was spent on excision of the liver tissue. The intra-operative blood loss ranged from 100 to 250 mL. Microscopically, the hydro-dissections were relatively precise and gentle, preserving most vessels.
CONCLUSION
The Erbe Jet2 water-jet system can safely accomplish non-anatomic wedge hepatic resection in NOTES, which deserves further studies to shorten the dissection time.