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Surgical Endoscopy
Published in: Surgical Endoscopy 3/2011

01-03-2011 | Dynamic Manuscript

“No scar” small bowel resection in a survival porcine model using transcolonic NOTES® and transabdominal approach

Authors: Elena Dubcenco, Teodor Grantcharov, Frank C. S. Eng, Catherine J. Streutker, Nancy N. Baxter, Ori D. Rotstein, Jeffrey P. Baker

Published in: Surgical Endoscopy | Issue 3/2011

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Abstract

Background

Fundamental techniques and essential tools for performing “no scar” surgery still need to be developed. Our study was designed to evaluate the feasibility of performing small bowel resection by transcolonic NOTES® and transabdominal approach using rigid laparoscopic and flexible endoscopic instruments.

Methods

One non survival and four survival experiments were performed using a porcine model. The endoscope with an overtube was advanced into the peritoneal cavity through the colotomy. Mini-laparoscopic instruments were placed through the abdominal wall under the endoscopic observation. The endoscope was replaced with a rigid linear stapler. The small bowel was identified. The segment of the small bowel was resected by firing the endo stapler, and extracted through the colon. The two limbs of the small bowel were approximated with two stay-sutures. An enterotomy was then created on the antimesenteric sides of each line. A side-to-side anastomosis was performed with another application of the endo stapler. The stapler was withdrawn. The enterotomy was closed by suturing. The colotomy was closed with endoclips and the endoscope was withdrawn. The mini-laparoscopic instruments were removed.

Results

Small bowel resection was successfully performed in all animals. The surgery time was 70 minutes. There was no mortality or complications. The animals recovered uneventfully, and survived the 2 weeks postprocedure period. They remained healthy, and gained weight. Necropsy was performed 2 weeks after the surgery. On necropsy, evaluation of the abdominal skin revealed no scars. The peritoneal cavity was examined. No signs of infection, bleeding, perforations, and adhesions were noted. Endoscopic examination of the colotomy and anastomosis revealed complete healing that was confirmed by histopathology.

Conclusions

The study has demonstrated the feasibility of small bowel resection using transcolonic NOTES® and transabdominal approach. Simultaneous use of flexible endoscopic and rigid laparoscopic instruments in NOTES® is not only feasible but has significant advantages and greatly facilitates the performance of the operation, yet leaves no scars.
Appendix
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Metadata
Title
“No scar” small bowel resection in a survival porcine model using transcolonic NOTES® and transabdominal approach
Authors
Elena Dubcenco
Teodor Grantcharov
Frank C. S. Eng
Catherine J. Streutker
Nancy N. Baxter
Ori D. Rotstein
Jeffrey P. Baker
Publication date
01-03-2011
Publisher
Springer-Verlag
Published in
Surgical Endoscopy / Issue 3/2011
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-010-1156-1

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