Natural Orifice Translumenal Endoscopic Surgery (NOTES) in Animals / 中国微创外科杂志

ABSTRACT

Objective To investigate the causes of success or failure of natural orifice translumenal endoscopic surgery(NOTES)in animals.Methods Data were collected from animal studies of NOTES carried out between August 2007 and September 2009.The studies were divided into acute phase and survival phase.In the studies,simple NOTES and laparoscopic-assisted NOTES were performed on female miniswines or adult mongrel dogs.Diagnostic abdominal exploration,liver biopsy,cholecystectomy,tubal ligation,oophorectomy,gastrojejunal anastomosis,and splenectomy were made in the animals.The intra-and post-operative complications and technical difficulties were recorded during the procedures.Results Totally 37 miniswines and 16 mongrel dogs were enrolled in the studies of NOTES procedures(91 procedures),including 22 acute experiments and 31 survival experiments.Simple NOTES was conducted through the transgastric route in 25 cases,transcolonic route in 8 cases,and combinations of transgastric and transcolonic routes in 16 cases,and combinations of transgastric and transvaginal routes in 6.In Laparoscopic-assisted cases,36 animals were treated via the transgastric route by traditional(26 cases)or single-port transumbilical laparoscopy(10 cases).Diagnostic exploration was carried out in 33 cases,liver biopsy was done in 11 cases,tubal ligation was made in 11,and oophorectomy was performed on 6;the procedures were all completed in these cases showing a success rate of 100%.Cholecystectomy was completed in 27 cases with a success rate of 44.4%(12/27).One case of splenectomy,and two cases of gastrojejunal anastomosis failed.The totally complication rate in the studies were 39.6%(21/53).The complications included perforation(8 cases),organ injury(5 cases),bleeding(4 cases),infection(3 cases)and pneumoperitoneum with hypertonia(1 case).Conclusions NOTES is feasible,safe and effective in diagnostic abdominal exploration and simple abdominal surgeries,but does not suit difficult abdominal surgeries.By using laparoscopy,the technique may be further developed and used in the future.