Biópsia hepática e peritoneal por laparoscopia ou por notes em suínos: comparação de parâmetros operatórios e evolução pós-operatória

Claus, Christiano Marlo Paggi; Bonin, Eduardo A.; Torres, María Fernanda; Campos, Antônio Carlos Ligocki; Cury, Antonio Moris; Coelho, Júlio Cezar Uili

doi:10.1590/s0100-69912011000400009

Cited by 3 publications

(2 citation statements)

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“…However, few studies have evaluated NOTES liver surgery in animals or humans 33 – 40 (Table 1 ). All experimental studies of NOTES LR involved only liver biopsy 33 , 34 or a small number of local resections (1 to 2 wedge liver resections 35 – 37 ). Only 3 human clinical case reports described the use of NOTES LR for partial liver resection or left lateral sectionectomy.…”

Section: Discussionmentioning

confidence: 99%

“…We believe that the present study is the first to establish a technical model for TV NOTES LR in a porcine model. NOTES LR uses various natural orifices, including the vagina, 33 stomach, 34 rectum, 35 37 and umbilicus, as access routes. Natural orifices are used for far more than specimen extraction by means of natural orifice specimen extraction (NOSE).…”

Section: Discussionmentioning

confidence: 99%

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Feasibility and Technique for Transvaginal Natural Orifice Transluminal Endoscopic Surgery Liver Resection: A Porcine Model

Katagiri

Otsuka

Horgan

et al. 2017

Surgical Laparoscopy, Endoscopy &Amp; Percutaneous Techniques

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Introduction:Natural orifice transluminal endoscopic surgery (NOTES) is a challenging minimally invasive procedure. Although laparoscopic techniques for liver resection are gaining acceptance worldwide, few studies have investigated NOTES liver resection. We used a porcine model to assess the feasibility and safety of transvaginal NOTES liver resection (TV NOTES LR).Materials and Methods:Nine female pigs underwent TV NOTES LR. A nonsurvival acute porcine model with general anesthesia was used in all cases. Using hybrid NOTES technique, we placed only 1 umbilical 12-mm umbilical trocar in the abdominal wall, which was used to create pneumoperitoneum. A laparoscope was then advanced to obtain intra-abdominal visualization. A 15-mm vaginal trocar was inserted under direct laparoscopic vision, and a flexible endoscope was introduced through the vaginal trocar. A long, flexible grasper and endocavity retractor were used to stably retract the liver. The liver edge was partially transected using energy devices inserted through the umbilical trocar. To transect the left lateral lobe, a flexible linear stapler was inserted alongside the vaginal trocar. A specimen extraction bag was deployed and extracted transvaginally. Blood loss, bile leakage, operative time, and specimen size were evaluated. Necropsy studies were performed after the procedures.Results:Eighteen transvaginal NOTES partial liver resections and 4 transvaginal NOTES left lateral lobectomies were successfully performed on 9 pigs. Mean operative time was 165.8 minutes, and mean estimated blood loss was 76.6 mL. All TV NOTES LRs were performed without complications or deaths. Necropsy showed no bile leakage from remnant liver.Conclusions:Our porcine model suggests that TV NOTES LR is technically feasible and safe and has the potential for clinical use as a minimally invasive alternative to conventional laparoscopic liver resection.

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