Pure NOTES Transvesical Venous Ligation: Translational Animal Model of Varicocelectomy

Abstract

OBJECTIVETo assess the feasibility of pure natural orifice transluminal endoscopic surgery (NOTES) transvesical venous ligation mimicking bilateral varicocelectomy in an animal model. MATERIALS AND METHODSTransvesical NOTES bilateral venous ligation was performed in 6 female pigs by considering lower epigastric vessels as a model for gonadal vessels. Under flexible cystoscopic guidance, a cystotomy was created on the anterior bladder. The flexible cystoscope was introduced through the over tube, and the lower epigastric vessels were visualized in retroflexion. Thulium laser was used to cut and coagulate the vessels. A bladder catheter was left in place for 4 days in all animals and they were sacrificed 15 days after the procedure. RESULTSThe procedure was successfully carried out in all animals without intraoperative complications. Epigastric vessels were safely cut and coagulated using the thulium laser. Median time for the overall procedure, including establishment of the transvesical port, was 23 minutes (range 20-30). No complications were encountered during the postoperative follow-up period. Postmortem examination revealed complete coagulation and separation of vessels. CONCLUSIONAn animal model mimicking a NOTES transvesical bilateral varicocelectomy procedure is successfully shown in the present study. Despite being encouraging, these novel findings need to be interpreted with caution. Further research is warranted and development of purpose-built instrumentation is awaited to define potential urological applications of transvesical NOTES. UROLOGY 78: 1082-1088, 2011. © 2011 V aricocele represents the most common correctable etiology found in adult men with infertility.

Feasibility of Transumbilical Flexible Endoscopic Preperitoneoscopy (FLEPP) and Its Utility for Inguinal Hernia Repair

“…Endoscopic clips can be used to seal the feeders to the dilated varicocele veins. Alternatively, a thulium laser (2 µm) beam, a precise but relatively "cold" energy source, can be used to cut and coagulate the varicocele vessels as described by Osório et al 27 in transvesical pure NOTES bilateral varicocelectomy and Boylu et al 24 for transgastric NOTES partial nephrectomy. Thus, theoretically though, TEP varicocelectomy can be entirely reproduced with the FLEPP technique.…”

Varicocele and Male Infertility: Current Issues in Management-A Review

“…Lima et al have recently pioneered natural orifice transluminal endoscopic surgical procedures (NOTES) to perform varicocelectomy as an important minimally invasive approach [66,67]. In addition, various studies have described the safety and efficacy of laproendscopic single-site (LESS) surgical repair of varicoceles [68,69].…”

Surgical management of adolescent varicocele: Systematic review of the world literature

“…Lima and co-workers[55] have recently pioneered natural orifice transluminal endoscopic surgical procedures (NOTES) to perform varicocelectomy as an important minimally invasive approach. [5556] In addition, various studies have thoroughly described the safety and efficacy of laparoendoscopic single-site (LESS) surgical repair of varicoceles.…”

“…[5556] In addition, various studies have thoroughly described the safety and efficacy of laparoendoscopic single-site (LESS) surgical repair of varicoceles. [3157] Essentially, both NOTES and LESS are hybrid modification of the laparoscopic technique.…”