AIM: To investigate the feasibility and safety of Natural orifice trans-umbilical endoscopic cholecystectomy with a water-jet hybrid-knife in a non-survival porcine model. METHODS: Pure natural orifice transluminal endoscopic surgery (NOTES) cholecystectomy was performed on three non-survival pigs, by transumbilical approach, using a water-jet hybrid-knife. Under general anesthesia, the following steps detailed the procedure: (1) incision of the umbilicus followed by the passage of a double-channel flexible endoscope through an overtube into the peritoneal cavity; (2) establishment of pneumoperitoneum; (3) abdominal exploration; (4) endoscopic cholecystectomy: dissection of the gallbladder performed using water jet equipment, ligation of the cystic artery and duct conducted using nylon loops; and (5) necropsy with macroscopic evaluation. RESULTS: Transumbilical endoscopic cholecystectomy was successfully completed in the first and third pig, with minor bleedings. The dissection times were 137 and 42 min, respectively. The total operation times were 167 and 69 min, respectively. And the lengths of resected specimen were 6.5 and 6.1 cm, respectively. Instillation of the fluid into the gallbladder bed produced edematous, distended tissue making separation safe and easy. Reliable ligation using double nylon loops insured the safety of cutting between the loops. There were no intraoperative complications or hemodynamic instability. Uncontrolled introperative bleeding occurred in the second case, leading to the operation failure. CONCLUSION: Pure NOTES trans-umbilical cholecystectomy with a water-jet hybrid-knife appears to be feasible and safe. Further investigation of this technique with long-term follow-up in animals is needed to confirm the preliminary observation.
AIM: To investigate the feasibility and safety of Natural orifice trans-umbilical endoscopic cholecystectomy with a water-jet hybrid-knife in a non-survival porcine model. METHODS: Pure natural orifice transluminal endoscopic surgery (NOTES) cholecystectomy was performed on three non-survival pigs, by transumbilical approach, using a water-jet hybrid-knife. Under general anesthesia, the following steps detailed the procedure: (1) incision of the umbilicus followed by the passage of a double-channel flexible endoscope through an overtube into the peritoneal cavity; (2) establishment of pneumoperitoneum; (3) abdominal exploration; (4) endoscopic cholecystectomy: dissection of the gallbladder performed using water jet equipment, ligation of the cystic artery and duct conducted using nylon loops; and (5) necropsy with macroscopic evaluation. RESULTS: Transumbilical endoscopic cholecystectomy was successfully completed in the first and third pig, with minor bleedings. The dissection times were 137 and 42 min, respectively. The total operation times were 167 and 69 min, respectively. And the lengths of resected specimen were 6.5 and 6.1 cm, respectively. Instillation of the fluid into the gallbladder bed produced edematous, distended tissue making separation safe and easy. Reliable ligation using double nylon loops insured the safety of cutting between the loops. There were no intraoperative complications or hemodynamic instability. Uncontrolled introperative bleeding occurred in the second case, leading to the operation failure. CONCLUSION: Pure NOTES trans-umbilical cholecystectomy with a water-jet hybrid-knife appears to be feasible and safe. Further investigation of this technique with long-term follow-up in animals is needed to confirm the preliminary observation.
Authors: Jong Jin Hyun; Hwang Rae Chun; Hoon Jai Chun; Yoon Tae Jeen; Chang Won Baeck; Sang Kyun Yu; Yong Sik Kim; Hong Sik Lee; Soon Ho Um; Sang Woo Lee; Jai Hyun Choi; Chang Duck Kim; Ho Sang Ryu; Jin Hai Hyun Journal: Scand J Gastroenterol Date: 2006-04 Impact factor: 2.423
Authors: Sergey V Kantsevoy; Sanjay B Jagannath; Hideaki Niiyama; Nina V Isakovich; Sydney S C Chung; Peter B Cotton; Christopher J Gostout; Robert H Hawes; Pankaj J Pasricha; Anthony N Kalloo Journal: Gastrointest Endosc Date: 2007-03 Impact factor: 9.427
Authors: Yoram Abramov; Sanjay Gandhi; Sylvia M Botros; Roger P Goldberg; Wendi Sherman; Margaret Rurak; Peter K Sand Journal: Am J Obstet Gynecol Date: 2005-05 Impact factor: 8.661
Authors: M Fujishiro; N Yahagi; K Kashimura; Y Mizushima; M Oka; S Enomoto; N Kakushima; K Kobayashi; T Hashimoto; M Iguchi; Y Shimizu; M Ichinose; M Omata Journal: Endoscopy Date: 2004-07 Impact factor: 10.093