ABSTRACT
Objective To perform partial nephrectomy via combined transgastric and transvesical approach in porcine and to use V-loc suture for suturing the renal defect, so as to further assess the safety and feasibility of combined transgastric and transvesical approach. Methods Three female pigs were used in this study. The transvesical access was established by incising the anterior wall of the bladder under ureteroscope, and a self-designed Trocar was inserted. Under the guidance of ureteroscopy, the transgastric accesswas established by a needle knife with cautery, and the gastroscope was introduced after balloon dilation. Under the guidance of gastroscope, laparoscopic ultrasonic scalpel was introduced via the bladder Trocar; the kidney artery and veinwere separated, the arteries were blocked and some lower part of renal parenchyma was resected; and the wound was closed by 2-0 V-loc suture which was introduced percutaneously. The specimens were collected from the bladder. Results Six partial nephrectomy procedureswere done in the 3 pigs. The first case was transferred to traditional laparoscopy due to incompleted blocking of the artery, bleeding and loss of vision. The rest 5 cases were successfully completed, with a mean operation time of 174 min(140-220 min), a warm ischemia time of 21 min (17-28 min), and with no significant bleeding. The average size of incised tissue was 1. 5 cm X1. 5 cm. Conclusion Partial nephrectomy via combined transgastric and transvesical approach is extremely difficult, but it can be done by using the V-loc suture and auxiliary needle laparoscopic instrument; however, its clinical prospect still needs further verification.
ABSTRACT
Objective To evaluate the feasibility and efficacy of betadine solution irrigation of gastrointestinal tract for infection prevention during the procedure of natural orifice transluminal endoscopic surgery(NOTES).Methods Twelve female porcine were divided into control group(n =4)to receive lavage with 500 ml normal saline and experimental group(n =8)to undergo lavage with 500 ml normal saline followed by 200 ml betadine solution.Fluid from gastrointestinal tract(5 ml)were collected before and after lavage,and after NOTES for culture.Endoscopy was performed 24 hours after NOTES to observe possible existence of inflammation,ulcer or bleeding.The animals were sacrificed 3 weeks after NOTES to explore intra-peritoneal adhesions,abscesses and other infections.Results One swine died of diaphragmatic injury and the other 11 animals successfully survived for 3 weeks.In trans-gastric approach,the average bacterial load of the fluid was 17.5 x 103 CFU/ml before lavage.In control group,the average bacterial load of the fluid was 2.5 × 103 CFU/ml after lavage and 5.5 × 103 CFU/ml after NOTES,while those in experimental group were 0 CFU/ml and 7.5 CFU/ml,respectively.In trans-colonic approach,the average bacterial load of the fluid before lavage was 76.2 × 103 CFU/ml.In control group,the average bacterial load of the fluid was 19.5 × 103 CFU/ml after lavage and 21 × 103 CFU/ml after NOTES,while those in experimental group were 2.25 × 103 CFU/ml and 1 × 103 CFU/ml,respectively.No inflammation,ulcer or bleeding were observed by endoscopy at 24 hours after NOTES.More adhesion and abscess were found in the control group than in the experimental group.In experimental group with trans-colonic approach,only one case of adhesion was observed.Conclusion It is effective and feasible of using betadine solution irrigation of gastrointestinal tract in infection prevention during the procedure of NOTES.However,further clinical studies assessing the effectiveness and safety are still necessary.