Transcolonic Perirectal NOTES Access (PNA): A feasibility study with survival in swine model

Abstract

Transrectal access still has some unsolved issues such as spatial orientation, infection, access and site closure. This study presents a simple technique to perform transcolonic access with survival in a swine model series. A new technique for NOTES perirectal access to perform retroperitoneoscopy, peritoneoscopy, liver and lymphnode biopsies was performed in 6 pigs, using Totally NOTES technique. The specimens were extracted transanally. The flexible endoscope was inserted through a posterior transmural incision and the retrorectal space. Cultures of bacteria were documented for the retroperitoneal space and intra abdominal cavity after 14 days. Rectal site was closed using non-absorbable sutures. There was no bowel cleansing, nor preoperative fasting. The procedures were performed in 6 pigs through transcolonic natural orifice access using available endoscopic flexible instruments. All animals survived 14 days without complications, and cultures were negative. Histopathologic examination of the rectal closure site showed adequate healing of suture line and no micro abscesses. The results of feasibility and safety of experimental Transcolonic NOTES potentially brings new frontiers and future wider applications for minimally invasive surgery. The treatment of colorectal, abdominal and retroperitoneal diseases through a flexible Perirectal NOTES Access (PNA) is a promising new approach.

MIEO: a micro-invasive endoscopic operation port system for transluminal interventions—an acute and survival porcine study

“…The technique to enter the abdomen, however, has remained almost unchanged. While some groups chose direct endoscope penetration [7,8], our group was the first to propose usage of a transluminal overtube [9] to penetrate the intestinal wall and establish a permanent gate to the abdominal wall. The so-called ISSA (innovative safe and sterile access) worked similarly to a laparoscopic trocar and to a certain extent was able to separate the endoscope from the intestinal lumen.…”

Endoscopic trans-esophageal submucosal tunneling surgery: A new therapeutic approach for diseases located around the aorta ventralis

“…In 2006, Rao et al[7] made the first attempt of transgastric NOTES in human. Subsequently, a number of scholars used NOTES to simulate a variety of intraperitoneal surgeries including cholecystectomy, colectomy, liver resection, and thyroidectomy in experimental animals[8-11]. A significant and hybrid model of NOTES was proposed for abdominal surgeries using transcutaneous rigid laparoscopes in combination with a flexible endoscope passing through a visceral incision[12,13].…”