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Surgical Endoscopy
Published in: Surgical Endoscopy 1/2013

01-01-2013

Transrectal peritoneal access with the submucosal tunnel technique in NOTES: a porcine survival study

Authors: Yohei Kono, Kazuhiro Yasuda, Kazuaki Hiroishi, Tomonori Akagi, Koji Kawaguchi, Kosuke Suzuki, Fumitaka Yoshizumi, Masafumi Inomata, Norio Shiraishi, Seigo Kitano

Published in: Surgical Endoscopy | Issue 1/2013

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Abstract

Background

Natural orifice transluminal endoscopic surgery (NOTES) procedures have been performed via transgastric, transvaginal, or transcolonic approaches. However, the transcolonic approach has potential disadvantages including intraperitoneal infection. To avoid such disadvantages, we applied the submucosal tunnel technique to transrectal peritoneal access in this study. Study aims are to clarify the technical feasibility of a submucosal tunnel method for transrectal abdominal access and to assess the healing process of the submucosal tunnel histopathologically.

Methods

The study comprised six female pigs. The following procedures were performed: (1) The mucosa was cut after injection of sodium hyaluronate into the submucosa at the upper rectum. (2) Submucosal tunneling was performed by endoscopic submucosal dissection technique. (3) A small incision was made at the end of the tunnel. (4) After transrectal peritoneoscopy, the mucosal incision site was closed with endoclips.

Results

Transrectal peritoneoscopy was successfully performed in all pigs. Necropsy revealed no findings of peritonitis. Histopathologic examination showed good healing of the submucosal tunnel. The wound healing process of the submucosal tunnel on postoperative day 7 was mainly in the inflammatory phase at the mucosal incision site, the proliferative phase at the submucosal tract, and the proliferative/remodeling phase at the seromuscular incision site.

Conclusions

The submucosal tunnel technique appears to be useful and safe for transrectal peritoneal access because healing at the seromuscular incision site proceeded rapidly.
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Metadata
Title
Transrectal peritoneal access with the submucosal tunnel technique in NOTES: a porcine survival study
Authors
Yohei Kono
Kazuhiro Yasuda
Kazuaki Hiroishi
Tomonori Akagi
Koji Kawaguchi
Kosuke Suzuki
Fumitaka Yoshizumi
Masafumi Inomata
Norio Shiraishi
Seigo Kitano
Publication date
01-01-2013
Publisher
Springer-Verlag
Published in
Surgical Endoscopy / Issue 1/2013
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-012-2441-y

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