Hybrid natural orifice transluminal endoscopic surgery (NOTES) for Roux-en-Y gastric bypass: an experimental surgical study in human cadavers

Abstract

Several factors made hNOTES-RYGBP very challenging and time-consuming. A lack of proper instrumentation resulting in insufficient tissue traction, countertraction, and instrument manipulation complicated several steps during the procedure. A combination of flexible with rigid endoscopic techniques offers specific advantages for components of this type of surgery. Changes in instrument design are required to improve more complex endosurgical procedures.

Transvaginal Natural Orifice Transluminal Endoscopic Surgery (Notes): Surgical Technique and Results

“…The surgical time was 87 minutes and there was no major complication. Some cases of transvaginal NOTES gastric bypass in human cadavers have been reported in the literature (Hagen et al, 2008;Madan et al, 2008). Nevertheless, several factors made this technique very challenging and time-consuming.…”

“…A combination of flexible with rigid endoscopic techniques offers specific advantages for aspects of this type of surgery. Changes in instrument design are required to improve ergonomics in more complex endosurgical procedures (Hagen et al, 2008). Allemann et al (2010) described their experience with the pure transvaginal access for exploration of the retroperitoneum in cadavers to simulate the procedure of nephrectomy, adrenalectomy and pancreatectomy.…”

On the suitability of Thiel cadavers for natural orifice transluminal endoscopic surgery (NOTES): surgical training, feasibility studies, and anatomical education

“…The addition of transgastric assistance in transanal rectosigmoid resection was also reported by the same surgical group to improve the length of the specimen retrieved in a swine model but not in human cadavers [1,50]. Almost all the studies involving cadavers in NOTES research and training used fresh frozen cadavers, with the exception of very few reports using Thiel [21] and formalin-fixed [4,16] cadavers.…”

“…Transgastric Access to the lesser sac 6 [10] Transgastric Access to the abdominal cavity 1 [11] Transgastric Intraabdominal exploration, cholecystectomy 8 [12] Transgastric and transcolonic Intraabdominal exploration 3 [13] Transvaginal Nephrectomy 3 [14] Transvaginal Nephrectomy 4 [15] Transvaginal Nephrectomy 2 a [16] Transvaginal Adrenalectomy 2 [17] Transvaginal Adrenalectomy 1 [18] Transvaginal and transgastric Cholecystectomy 1 [19] Transvaginal and transgastric Gastric bypass Roux-en-Y 1 [20] Transvaginal hybrid Gastric bypass Roux-en-Y 5 ? 2 b [21] Transvaginal hybrid Access to the abdominal cavity 2 [22] Transvesical Peritoneoscopy 2 [23] Transvesical Prostatectomy 4 [24] Surg Endosc…”

Scarless Bariatric Surgery

“…The implication on bariatric surgery was only reported in sleeve gastrectomy and adjustable gastric banding with hybrid method, combining laparoscopic and endoscopic approach [4][5][6]. For more complicated procedures, such as gastric bypass are still at experimental stage [7].…”