Ann Surg Treat Res.  2014 Jul;87(1):1-4. 10.4174/astr.2014.87.1.1.

Transanal natural orifice transluminal endoscopic surgery total mesorectal excision in animal models: endoscopic inferior mesenteric artery dissection made easier by a retroperitoneal approach

• Park SJ
• Sohn DK
• Chang TY
• Jung Y
• Kim HJ
• Kim YI
• Chun HK
• Korea Natural Orifice Transluminal Endoscopic Surgery (K-NOTES) Study Group

• KMID: 1804091
• DOI: http://doi.org/10.4174/astr.2014.87.1.1

Abstract

PURPOSE
We report the performance of natural orifice transluminal endoscopic surgery (NOTES) low anterior resection in animals using transanal total mesorectal excision (TME) with laparoscopic assistance and endoscopic inferior mesenteric artery (IMA) dissection.
METHODS
Four pigs weighing 45 kg each, and one dog weighing 25 kg, underwent surgery via a transanal approach. The rectum was occluded transanally using a purse-string suture, approximately 3-4 cm from the anal verge. The rectal mucosa was incised circumferentially just distal to the purse-string. A SILS or GelPOINT port was inserted transanally. Transanal TME was assisted by laparoscopy and proceeded up to the peritoneal reflection. More proximal dissection, including IMA dissection, was performed along the retroperitoneal avascular plane by endoscopy alone and facilitated by CO2 insufflation. The IMA was clipped and divided endoscopically. The mobilized rectosigmoid were exteriorized transanally and transected. A colorectal anastomosis was performed using a circular stapler with a single stapling technique.
RESULTS
Endoscopic dissection of the IMA was successful in all five animals. The mean operation time was 125 minutes (range, 90-170 minutes). There were no intraoperative complications or hemodynamic instability. The mean length of the resected specimen was 14.4 cm (range, 12-16 cm).
CONCLUSION
A NOTES retroperitoneal approach to the IMA with CO2 insufflation and intact peritoneal covering overcame the difficulties of retraction and exposure of endoscopic dissection in animals.

Keyword

Natural orifice transluminal endoscopic surgery; Retroperitoneal approach; Total mesorectal excision; Inferior mesenteric artery

MeSH Terms

Animals
Dogs
Endoscopy
Hemodynamics
Insufflation
Intraoperative Complications
Laparoscopy
Mesenteric Artery, Inferior*
Models, Animal*
Mucous Membrane
Natural Orifice Endoscopic Surgery*
Rectum
Sutures
Swine

Figure

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  Fig. 1 Procedure of NOTES low anterior resection (Video clip can be operated via http://www.astr.or.kr/src/sm/astr-87-1-s001.mpg).

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