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01-04-2013 | Original Article

Endolumenal colon occlusion device for transanal and transrectal surgery—a porcine feasibility study

Authors: Georg R. Linke, Benedict Carstensen, Georg Kähler, Andreas Zerz, Maxym Shevchenko, Rene Warschkow, Felix Lasitschka, Hannes G. Kenngott, Jonas Senft, Beat P. Müller-Stich

Published in: Langenbeck's Archives of Surgery | Issue 4/2013

Abstract

Purpose

Although several studies have demonstrated the feasibility of transrectal natural orifice translumenal endoscopic surgery (NOTES), its clinical application has been hindered by concerns regarding potential infectious complications. The aim of this study was to evaluate the feasibility of a newly developed device for endolumenal colon occlusion (ColoShield) in an acute porcine model.

Methods

The principle of the ColoShield device is based on two balloons, with negative pressure in between. The ColoShield device and a gauze tamponade as a control group were evaluated in a non-survival study on 16 pigs. The efficacy of the occlusion system in establishing a leak-proof pneumorectum and in sealing the colon from proximal (watertight sealing) was tested by a standardized study course. Finally, the colon/rectum was explanted for macroscopic and microscopic examination.

Results

A 20-mmHg leak-proof pneumorectum over a period of 10 min could be achieved in seven of eight (87 %) animals with the ColoShield device and in none of eight (0 %) animals with gauze tamponade (p < 0.001). In the watertight sealing test, mean intracolonic pressures of 23.5 ± 18.1 (0–53) mmHg using the ColoShield device and 0 ± 1.1 (0–3) mmHg using gauze tamponade (p = 0.003) were documented proximal to the occlusion system before a leakage occurred. Macroscopic and histopathological examinations revealed no significant impairment of the colon specimen in either group.

Conclusions

ColoShield proved to be a safe and effective device for a reversible endolumenal colon occlusion. Further studies should evaluate its impact on procedural sterility during transrectal NOTES.

Santos BF, Hungness ES (2011) Natural orifice translumenal endoscopic surgery: progress in humans since white paper. World J Gastroenterol 17:1655–1665PubMedCrossRef

Khashab MA, Kalloo AN (2012) NOTES: current status and new horizons. Gastroenterology 142:704–710PubMedCrossRef

Moris DN, Bramis KJ, Mantonakis EI, Papalampros EL, Petrou AS, Papalampros AE (2012) Surgery via natural orifices in human beings: yesterday, today, tomorrow. Am J Surg 204:93–102PubMedCrossRef

Meining A, Wilhelm D, Burian M, Dundoulakis M, Schneider A, von Delius S, Feussner H (2007) Development, standardization, and evaluation of NOTES cholecystectomy using a transsigmoid approach in the porcine model: an acute feasibility study. Endoscopy 39:860–864PubMedCrossRef

Ryou M, Fong DG, Pai RD, Sauer J, Thompson CC (2008) Evaluation of a novel access and closure device for NOTES applications: a transcolonic survival study in the porcine model (with video). Gastrointest Endosc 67:964–969PubMedCrossRef

Fan JK, Tong DK, Law WL, Law S (2009) Transrectal intraperitoneal assess with transanal endoscopic operation (TEO) device in pig model. Surg Laparosc Endosc Percutan Tech 19:e109–e112PubMedCrossRef

Bazzi WM, Wagner O, Stroup SP, Silberstein JL, Belkind N, Katagiri T, Paleari J, Duro A, Ramamoorthy S, Talamini MA, Horgan S, Derweesh IH (2011) Transrectal hybrid natural orifice transluminal endoscopic surgery (NOTES) nephrectomy in a porcine model. Urology 77:518–523PubMedCrossRef

Bachman SL, Sporn E, Furrer JL, Astudillo JA, Calaluce R, McIntosh MA, Miedema BW, Thaler K (2009) Colonic sterilization for natural orifice translumenal endoscopic surgery (NOTES) procedures: a comparison of two decontamination protocols. Surg Endosc 23:1854–1859PubMedCrossRef

Denk PM, Swanstrom LL, Whiteford MH (2008) Transanal endoscopic microsurgical platform for natural orifice surgery. Gastrointest Endosc 68:954–959PubMedCrossRef

10.

Whiteford MH, Denk PM, Swanstrom LL (2007) Feasibility of radical sigmoid colectomy performed as natural orifice translumenal endoscopic surgery (NOTES) using transanal endoscopic microsurgery. Surg Endosc 21:1870–1874PubMedCrossRef

11.

Santos BF, Hungness ES, Boller AM (2011) Development of a feasible transrectal natural orifice transluminal endoscopic surgery (NOTES(R)) approach in a cadaveric appendectomy model: anterior is better. Surg Endosc 25:3773–3783PubMedCrossRef

12.

Ramamoorthy SL, Fischer LJ, Jacobsen G, Thompson K, Wong B, Spivack A, Cullen J, Talamini MA, Horgan S (2009) Transrectal endoscopic retrorectal access (TERA): a novel NOTES approach to the peritoneal cavity. J Laparoendosc Adv Surg Tech A 19:603–606PubMedCrossRef

13.

Wilhelm D, Meining A, von Delius S, Fiolka A, Can S, von Hann WC, Schneider A, Feussner H (2007) An innovative, safe and sterile sigmoid access (ISSA) for NOTES. Endoscopy 39:401–406PubMedCrossRef

14.

Fong DG, Ryou M, Pai RD, Tavakkolizadeh A, Rattner DW, Thompson CC (2007) Transcolonic ventral wall hernia mesh fixation in a porcine model. Endoscopy 39:865–869PubMedCrossRef

15.

Pai RD, Fong DG, Bundga ME, Odze RD, Rattner DW, Thompson CC (2006) Transcolonic endoscopic cholecystectomy: a NOTES survival study in a porcine model (with video). Gastrointest Endosc 64:428–434PubMedCrossRef

16.

Fong DG, Pai RD, Thompson CC (2007) Transcolonic endoscopic abdominal exploration: a NOTES survival study in a porcine model. Gastrointest Endosc 65:312–318PubMedCrossRef

17.

Leroy J, Costantino F, Cahill RA, D'agostino J, Morales A, Mutter D, Marescaux J (2011) Laparoscopic resection with transanal specimen extraction for sigmoid diverticulitis. Br J Surg 98:1327–1334PubMedCrossRef

18.

Eshuis EJ, Voermans RP, Stokkers PC, van Berge Henegouwen MI, Fockens P, Bemelman WA (2010) Laparoscopic resection with transcolonic specimen extraction for ileocaecal Crohn's disease. Br J Surg 97:569–574PubMedCrossRef

19.

Costantino FA, Diana M, Wall J, Leroy J, Mutter D, Marescaux J (2012) Prospective evaluation of peritoneal fluid contamination following transabdominal vs. transanal specimen extraction in laparoscopic left-sided colorectal resections. Surg Endosc 26:1495–1500PubMedCrossRef

20.

Chiu CJ, McArdle AH, Brown R, Scott HJ, Gurd FN (1970) Intestinal mucosal lesion in low-flow states. I. A morphological, hemodynamic, and metabolic reappraisal. Arch Surg 101:478–483PubMedCrossRef

21.

Dubcenco E, Grantcharov T, Streutker CJ, Rotstein OD, Baxter NN, Jeejeebhoy KN, Baker JP (2008) The development of a novel intracolonic occlusion balloon for transcolonic natural orifice transluminal endoscopic surgery: description of the technique and early experience in a porcine model (with videos). Gastrointest Endosc 68:760–766PubMedCrossRef

22.

Lamade W, Schymik K, Rieber F, Friedrich C, Etzrodt J, Ulmer C, Thon KP (2011) Snake charmer NOTES—proctocolectomy in a male patient. Chirurg 82:719–722PubMedCrossRef

23.

Lamade W, Rieber F, Kohler P, Friedrich C, Diederich M, Basar T, Ulmer C, Thon KP, Bernhardt J (2011) Snake charmer NOTES: a two-luminal access for hybrid NOS operations. Minim Invasive Ther Allied Technol 20:257–262PubMedCrossRef

Title: Endolumenal colon occlusion device for transanal and transrectal surgery—a porcine feasibility study
Authors: Georg R. Linke
Benedict Carstensen
Georg Kähler
Andreas Zerz
Maxym Shevchenko
Rene Warschkow
Felix Lasitschka
Hannes G. Kenngott
Jonas Senft
Beat P. Müller-Stich
Publication date: 01-04-2013
Publisher: Springer-Verlag
Published in: Langenbeck's Archives of Surgery / Issue 4/2013
Print ISSN: 1435-2443
Electronic ISSN: 1435-2451
DOI: https://doi.org/10.1007/s00423-013-1074-5

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Endolumenal colon occlusion device for transanal and transrectal surgery—a porcine feasibility study

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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