Comparative study of NOTES rectosigmoidectomy in a swine model: E-NOTES vs. P-NOTES

Sohn, Dae Kyung; Jeong, Sun Young; Park, J. W.; Kim, J. S.; Hwang, Jae Ha; Kim, D.-W.; Kang, Sung Bum; Oh, Jae Hwan

doi:10.1055/s-0030-1256239

Cited by 30 publications

(22 citation statements)

References 24 publications

(44 reference statements)

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“…64,[93][94][95][96][97][98][99][100][101][102][103] In the largest cadaver series to date (n = 32), our group demonstrated the feasibility of pure and hybrid transanal NOTES rectosigmoid resection, with an intact mesorectum demonstrated in all cadavers (Fig. 1).…”

Section: Transanal Notes Rectosigmoid Resection: Experimental Resultsmentioning

confidence: 66%

Transanal colorectal resection using natural orifice translumenal endoscopic surgery (NOTES)

Emhoff

Lee

Sylla

2013

Digestive Endoscopy

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The surgical management of rectal cancer has evolved over the past century, with total mesorectal excision (TME) emerging as standard of care. As a result of the morbidity associated with open TME, minimally invasive techniques have become popular. Natural orifice translumenal endoscopic surgery (NOTES) has been held as the next revolution in surgical techniques, offering the possibility of 'incisionless' TME. Early clinical series of transanal TME with laparoscopic assistance (n = 72) are promising, with overall intraoperative and postoperative complication rates of 8.3% and 27.8%, respectively, similar to laparoscopic TME. The mesorectal specimen was intact in all patients, and 94.4% had negative margins. There was no oncological recurrence in average-risk patients at short-term follow up, and 2-year survival rates in high-risk patients were comparable to that after laparoscopic TME. These preliminary studies demonstrate transanal NOTES TME with laparoscopic assistance to be clinically feasible and safe given careful patient selection, surgical expertise, and appropriate procedural training. We are hopeful that with optimization of transanal instruments and surgical techniques, pure transanal NOTES TME will become a viable alternative to open and laparoscopic TME in the future.

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Section: Transanal Notes Rectosigmoid Resection: Experimental Resultsmentioning

confidence: 66%

Transanal colorectal resection using natural orifice translumenal endoscopic surgery (NOTES)

Emhoff

Lee

Sylla

2013

Digestive Endoscopy

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“…13 The feasibility and safety of trans-anal proctectomy and trans-rectal rectosigmoid resection has been demonstrated in human cadavers and porcine survival models using the rigid trans anal endoscopic platform. 14–22 The first clinical case utilizing a rigid trans anal endoscopic platform to perform trans-anal total mesorectal excision with laparoscopic assistance in a 76 year old woman with rectal cancer (pre-operative clinical stage T2N2M0) was published in 2010. 23 The outcome of this case demonstrated patient safety, accelerated recovery, and good short term oncologic outcomes.…”

Section: Introductionmentioning

confidence: 99%

TAMIS-assisted laparoscopic low anterior resection with total mesorectal excision in a cadaveric series

et al. 2013

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Background The purpose of this study is to demonstrate the feasibility of an innovative technique for the surgical management of rectal cancer: trans anal minimally invasive surgery assisted low anterior resection with total mesorectal excision (TAMIS assisted LAR TME) in a cadaver model. Trans anal endoscopic low anterior resection via natural orifice translumenal endoscopic surgery (NOTES) has been reported in cadaveric series using rigid trans anal endoscopic platforms. This procedure has not been described using a combination of a single incision laparoscopy and TAMIS soft trans anal endoscopic platform. Herein, we describe the first cadaveric series of TAMIS assisted single incision laparoscopic LAR with TME. Methods TAMIS assisted laparoscopic single incision LAR with TME was successfully performed in 5 fresh male human cadavers. The procedure was performed using the mini-Gelpoint single incision platform and the Gelpoint Path TAMIS platform (Applied Medical, Rancho Santa Margarita, CA). The variables recorded were age, body mass index (BMI in kg/m2), operative time, complications, and specimen length. The grade of the TME was determined by evaluation of the specimen by photo documentation by a gastrointestinal pathologist. Results All cadavers were male with a mean age of 71 +/− 8 years and mean BMI of 28 +/− 3 kg/m2. The mean operative time was 200 +/− 55 minutes (range 128 – 249 min). The quality of the TME was Grade I (complete) with intact mesorectum in all five cases. The mean specimen length was 36.8 +/− 3.4 cm. Intra-operative complications included one bowel injury and one splenic capsular tear. Conclusions TAMIS assisted laparoscopic LAR with TME is feasible in this pre-clinical cadaveric series. We have also demonstrated that a high quality TME can be achieved with this technique. Trans anal endoscopic techniques employed to perform total mesorectal dissection may revolutionize the surgical management of rectal cancer. However, phase II clinical trials are needed to further evaluate the oncologic safety and surgical outcomes of trans anal endoscopic TME using various platforms prior to widespread application of this new technique.

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“…Whiteford et al [4] described the use of exclusively transanal NOTES sigmoidectomy in three human cadavers, using existing transanal endoscopic microsurgery (TEM) equipment. Since then, there have been extensive cadaveric and animal studies demonstrating the feasibility and safety of taTME with or without laparoscopic assistance [5][6][7][8][9][10][11][12][13][14][15][16]. In 2010, the first clinical case of a hybrid taTME for rectal cancer was reported by Sylla et al [17]; since then, taTME has been performed in over 16 clinical series involving at least 150 patients.…”

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confidence: 99%

Initial experience of transanal total mesorectal excision with rigid or flexible transanal platforms in cadavers

Kim

Park

et al. 2015

Surg Endosc

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Comparative study of NOTES rectosigmoidectomy in a swine model: E-NOTES vs. P-NOTES

Abstract: E-NOTES rectosigmoidectomy in the swine model is safe, but remains challenging for use in pelvic dissection. P-NOTES rectosigmoidectomy using TEM may be a promising tool for pelvic dissection, but the transgastric approach involves a high degree of risk.

Cited by 30 publications

References 24 publications

Transanal colorectal resection using natural orifice translumenal endoscopic surgery (NOTES)

Transanal colorectal resection using natural orifice translumenal endoscopic surgery (NOTES)

TAMIS-assisted laparoscopic low anterior resection with total mesorectal excision in a cadaveric series

Initial experience of transanal total mesorectal excision with rigid or flexible transanal platforms in cadavers

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