Transvesical peritoneoscopy with rigid scope: feasibility study in human male cadaver

Abstract

Background Transvesical port refers to the method of accessing the abdominal cavity through a natural orifice (i.e., urethra) under endoscopic visualization. Since its introduction in 2006, various reports have been published describing different surgical interventions using a rigid ureteroscope in a porcine model. The aim of this study was to test the access and feasibility of peritoneoscopy by using a rigid ureteroscope in a human male cadaver.Methods Two adult male cadavers were used to perform the procedures. A rigid ureteroscope was used for the creation of transvesical access into the peritoneal cavity. Peritoneoscopy, liver biopsy, and identification and manipulation of the ileocecal appendix were performed. Results Transvesical access into the peritoneal cavity was quickly established. The rigid ureteroscope easily allowed visualization of the abdominal cavity with good image quality. Liver biopsy and manipulation of ileocecal appendix were carried out without difficulties. Conclusions Peritoneoscopy, liver biopsy, and ileocecal appendix manipulation using a rigid ureteroscope through a transvesical port is feasible in a cadaver model. The development of a specific rigid scope for the transvesical port might herald a promising future for this NOTES access.

Pure NOTES Transvesical Venous Ligation: Translational Animal Model of Varicocelectomy

“…Median time for the overall procedure, including establishment of the transvesical port, was 23 minutes (range [20][21][22][23][24][25][26][27][28][29][30]. Procedure time decreased with experience.…”

“…Attempting to answer this question, Branco et al recently reported that peritoneoscopy and liver biopsy using a rigid ureteroscope through a transvesical port is feasible in a human male cadaver. 29 For bilateral varicocelectomy, one of the major problems of this route may be the length of the male urethra, because the flexible video cystourethroscope size is short. Probably, in the near future, biomedical engineering will need to develop longer scopes and instruments.…”

“…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.…”

Disinfection of the Access Orifice in NOTES: Evaluation of the Evidence Base

“…The same group has also published further series to include transvesical transdiaphragmatic thoracoscopy as well combined transgastric-transvesical approaches to cholecystectomy [31] and nephrectomy [32]. Initial feasibility studies have also been performed in human cadaver [33] models. A case series of 60 human patients undergoing laparoscopic prostatectomy reported minimal contamination of the peritoneum following cystotomy, with positive bacterial cultures in 5 patients, however with no clinical significance and subsequent good recovery without further intervention required [34].…”

Transvesical natural orifice transluminal endoscopic surgery (NOTES) nephrectomy with kidney morcellation: a proof of concept study

“…This might account for two cases of urethral laceration. This complication is not likely to happen in the human urethra as it easily holds tools up to 10 mm [23], but the risk of urethral stricture in transvesical procedures should nevertheless be assessed in humans.…”