Transrectal robotic natural orifice translumenal endoscopic surgery (NOTES) applied to intestinal anastomosis in a porci
- PDF / 393,177 Bytes
- 9 Pages / 595.276 x 790.866 pts Page_size
- 52 Downloads / 191 Views
and Other Interventional Techniques
Transrectal robotic natural orifice translumenal endoscopic surgery (NOTES) applied to intestinal anastomosis in a porcine intestine model Yoshitaka Demura • Norihiko Ishikawa Yasumitsu Hirano • Noriyuki Inaki • Aika Matsunoki • Go Watanabe
•
Received: 11 February 2013 / Accepted: 17 July 2013 / Published online: 27 August 2013 Ó Springer Science+Business Media New York 2013
Abstract Background Natural orifice translumenal endoscopic surgery (NOTES) is a minimally invasive operation using devices such as flexible endoscopes and linear or circular staplers. Nevertheless, hand-sewn anastomosis in NOTES remains challenging. This study aimed to investigate the feasibility of transrectal robotic NOTES requiring intracorporeal small intestinal anastomosis and closure of the rectal anterior wall incision in a relevant human model. Methods The authors developed a flexible rectal proctoscope with a diameter of 43 mm for transrectal robotic NOTES. Small intestinal anastomosis was performed in a porcine intestinal transrectal NOTES model using two robotic arms and a camera inserted through the proctoscope and a rectal anterior wall incision. The quality of transrectal small intestinal anastomosis using the da Vinci surgical system (transrectal robotic NOTES group) was compared with that of transabdominal anastomosis using the da Vinci surgical system (transabdominal robot-assisted surgery group) and transrectal anastomosis using traditional transanal endoscopic microsurgery (TEM) instruments (TEM NOTES group). The quality of transrectal rectal anterior wall suturing in the transrectal robotic NOTES group was compared with that of the TEM NOTES group and the open surgical instruments group (open group). Results Robotic intracorporeal suturing was performed successfully in the porcine intestine model. During small
Y. Demura (&) N. Ishikawa Y. Hirano N. Inaki A. Matsunoki G. Watanabe Department of General and Cardiothoracic Surgery, Kanazawa University, 13-1 Takaramachi, Kanazawa 920-8641, Japan e-mail: [email protected]
intestinal anastomosis, burst pressure in the transrectal robotic NOTES group (67.7 ± 29.3 mmHg) was similar to that in the transabdominal robot-assisted surgery group (73.3 ± 18.2 mmHg) but significantly higher than in the TEM NOTES group (20.3 ± 24.0 mmHg; p \ 0.01). During rectal anterior wall suturing, the burst pressure did not differ significantly between the transrectal robotic NOTES group (149.9 ± 81.1 mmHg) and the open group (195.0 ± 60.5 mmHg). Conclusions The preliminary safety and efficacy of transrectal robotic NOTES was established. Further studies are required to determine the practical feasibility of this procedure. Keywords NOTES Robotic surgery Transrectal Anastomosis
Natural orifice translumenal endoscopic surgery (NOTES) is a minimally invasive surgical procedure [1]. The NOTES procedure avoids incisions in the abdominal wall and theoretically provides patient benefits by minimizing tissue trauma, postoperative pain, and potential wou
Data Loading...
