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

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.

Endoscopic Cecectomy with Hybrid Natural Orifice Transluminal Endoscopic Surgery (NOTES) in Canine Models

PURPOSE: Natural orifice transluminal endoscopic surgery (NOTES) is a new operation technique that utilizes natural orifices of the patient's body with the intention to puncture hollow viscera in order to insert an endoscope into a peritoneal cavity for incisionless surgery. The aim of this study was to evaluate the safety and feasibility of endoscopic cecectomy through the rectum in one dog and the vagina in another dog. METHODS: This study was performed in two beagle dogs for rectal and vaginal approaches. A five-milimeter trocar was inserted into the abdominal cavity by the Hasson method and intra-abdominal pressure was maintained at 5 mmHg with CO2. After pneumoperitoneum was accomplished, the rectum or vagina was incised with a needle knife and a one-channel gastric endoscope was inserted into the abdominal cavity. Counter-traction was performed using a laparoscopic grasper introduced via the 5 mm trocar in the umbilicus. The cecum was dissected from the base by using a needle knife with the aid of laparoscopic counter-traction. The resected cecum was retrieved through the anus or vagina without pouch bag. The incised rectum was closed by using 90-degree endoclips whereas the incised vagina was not repaired. RESULTS: Cecectomies were successfully performed with both transrectal and transvaginal routes. Both cases had no complication and recovered from surgery uneventfully. CONCLUSION: Endoscopic cecectomy with hybrid NOTES are feasible and safe. With the improvement of surgical experiences and further instrumental development, NOTES can be one option for human intestinal surgery.

Transgastric Gastroscopic Intra-abdominal Exploration in a Female Dog Model: NOTES (Natural Orifice Transluminal Endoscopic Surgery)

PURPOSE: Natural orifice transluminal endoscopic surgery (NOTES) is a new surgical option using endoscopic advancement to the peritoneal cavity through the stomach, colon, vagina, or urinary bladder without an abdominal wall scar (incision). The aim of this study was to assess the feasibility of transgastric gastroscopic intra-abdominal exploration with gastric incision and closure before the NOTES would be done. METHODS: Under general anesthesia of a female dog, one-channel gastroscope was advanced to the stomach and the lumen was irrigated with anti-bacterial solution. The anterior wall of the antrum was incised by about 1 cm with a needle knife; then, the gastroscope was advanced into the peritoneal cavity. An exploration of the entire intra-abdominal cavity was performed. RESULTS: We were able to evaluate the stomach, the greater omentum, the diaphragm, the peritoneum, the urinary bladder, the bowel, the spleen, the liver, the gallbladder, the uterine horn, the uterine body, and the vagina, but could not evaluate the ovary, the kidney, and the pancreas. The observation of the abdominal cavity was followed by the gastric wall closure with a 135o endoclip. The dog was recovered after confirmation of secure closure of the incision site. CONCLUSIONS: Transgastric incision, closure, and abdominal exploration are feasible without an abdominal wall scar, and the NOTES can be one option for future abdominal operations in humans and needs to be further investigated.

The Factors Related to Surgical Success Rate of Endonasal Dacryocystorhinostomy

Endonasal DCR has been reported for the advantages of lack of a cutaneous scar and short operating time but that the surgical success rates were lower than conventional method. We have performed endonasal DCR and had follow-up of at least 6 months in 107 patients who had been diagnosed with lacrimal pathway obstruction, and also surveyed the age, sex, sac size and nasal cavity abnormality to evaluate the factors related to success rate. Primary success rates were 82.2%(88eyes) and higher success rates were noted in younger age, man and large sac but not significant. But. the cases associated with nasal cavity abnormality as septal deviation, middle turbinate hypertrophy, ethmoiditis and polyp showed poor surgical results due to membranous ostium closure, formation of granuloma within the ostium, and formation of cicatrix with the middle turbinate.(P<0.05) Improvement of success rate may be owing to appropriate preoperative evaluation, proper management of nasal cavity abnormality preoperatively and intraoperatively, and show consider the conventional method in cases of that lower success rate are predict.

The treatment of septic arthritis of the knee / 대한정형외과학회잡지

No abstract available.

A clinical study on operative treatment of spondylolisthesis / 대한정형외과학회잡지

No abstract available.

The effects of experimental ocular hypertension on the electroretinogram and ultrastructure of the retina in rabbits

Intragcular pressure (lOP) was artificially elevated and maintained in rabbits for up to 12 hours at levels 40, 60, 80, and 100 mmHg. Electroretinographic (ERG) responses showed gradual decline and later disappeared depending on the pressure. ERG responses were initially normal to supernormal at all lOP levels except 100 mmHg, and then showed gradual decline to extinction except in one eye of the 40 mmHg group. Ultrastrurtural damage was also pressure and time dependent. After 12 hours of the increased lOP, no damage to the ultrasfrurture of the retina was detected at 40mmHg, although the ERG was severely affected. Electron microscopic studies showed flattening of the pigment epithelium and swelling of mitochondria which appeared first at 60 mmHg; severe damage of mitochondria and the basal infoldings of the pigment epithelium at 80mmHg; and severe damage of all the retinal tissues at 100 mmHg. The critical duration of the elevated lOP which decreased the amplitude of the ERG was found to be 5 hours for 40 mmHg, 1 hour for 60 mmHg, and 30 minutes for 80 mmHg. The critical lOP which affected the ultrastrurture after 12 hours, lied between 40 and 60 mmHg.