Natural orifice transluminal endoscopic surgery (NOTES) is a growing new surgical technique that allows minimally invasive access to the peritoneal cavity for the diagnosis and treatment of abdominal pathologies, while avoiding abdominal- wall incisions and the related complications. Since 2004, NOTES procedures, such as peritoneoscopy, 1 biopsies,2 tubal ligations,3 cholecystectomy,4,5 and gastrojejunal anastomosis,6,7 have been successfully explored in the pig model. In March 2007, Bessler et al8 successfully performed the first human transvaginal laparoscopically assisted endoscopic cholecystectomy, and, in April 2007, Marescaux et al9 demonstrated the first completely transvaginal cholecystectomy.Herein we will report our preliminary experience with NOTES. Transvaginal access to the peritoneal cavity is a well established and safe procedure used by gynecologists for fertiloscopy. 10 Our preliminary experience demonstrates the technical feasibility and safety of the transvaginal access for laparoscopic-assisted cholecystectomy; once pelvic anomalies or diseases are excluded by objective assessment (TVUS, magnetic resonance imaging, or CT). The procedure is well tolerated by patients (probably because of a single minimal abdominal-wall scar and less intraoperative peritoneal stretching) and allows for reduced recovery times, with improved cosmetic outcomes. Dedicated NOTES platforms and devices are needed to achieve completely ‘‘no-scar’’ procedures, which provide for safe creation and closure of the viscerotomy11 (ie, gastrotomy) and increasing the ease of intra-abdominal organ manipulation.12 So the transvaginal approach is the safer access for NOTES to date because of the easiness in performing and closing the colpotomy. Until the availability of dedicated NOTES instruments, we believe the best technique is the hybrid, because it ensures control of the endoscope entry into the peritoneal cavity, which allows a safer and faster procedure. Through technical improvements and clinical trials, NOTES will soon be the future of minimally invasive surgery.
Transvaginal laparoscopically assisted endoscopic cholecystectomy: report of 3 cases.
Graziosi L.;CAVAZZONI, Emanuel;DONINI, Annibale
2008
Abstract
Natural orifice transluminal endoscopic surgery (NOTES) is a growing new surgical technique that allows minimally invasive access to the peritoneal cavity for the diagnosis and treatment of abdominal pathologies, while avoiding abdominal- wall incisions and the related complications. Since 2004, NOTES procedures, such as peritoneoscopy, 1 biopsies,2 tubal ligations,3 cholecystectomy,4,5 and gastrojejunal anastomosis,6,7 have been successfully explored in the pig model. In March 2007, Bessler et al8 successfully performed the first human transvaginal laparoscopically assisted endoscopic cholecystectomy, and, in April 2007, Marescaux et al9 demonstrated the first completely transvaginal cholecystectomy.Herein we will report our preliminary experience with NOTES. Transvaginal access to the peritoneal cavity is a well established and safe procedure used by gynecologists for fertiloscopy. 10 Our preliminary experience demonstrates the technical feasibility and safety of the transvaginal access for laparoscopic-assisted cholecystectomy; once pelvic anomalies or diseases are excluded by objective assessment (TVUS, magnetic resonance imaging, or CT). The procedure is well tolerated by patients (probably because of a single minimal abdominal-wall scar and less intraoperative peritoneal stretching) and allows for reduced recovery times, with improved cosmetic outcomes. Dedicated NOTES platforms and devices are needed to achieve completely ‘‘no-scar’’ procedures, which provide for safe creation and closure of the viscerotomy11 (ie, gastrotomy) and increasing the ease of intra-abdominal organ manipulation.12 So the transvaginal approach is the safer access for NOTES to date because of the easiness in performing and closing the colpotomy. Until the availability of dedicated NOTES instruments, we believe the best technique is the hybrid, because it ensures control of the endoscope entry into the peritoneal cavity, which allows a safer and faster procedure. Through technical improvements and clinical trials, NOTES will soon be the future of minimally invasive surgery.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
