Transanal natural orifice transluminal endoscopic surgery total mesorectal excision in animal models: endoscopic inferior mesenteric artery dissection made easier by a retroperitoneal approach
- Authors
- Park, Sun Jin; Sohn, Dae Kyung; Chang, Tae Young; Jung, Yunho; Kim, Hyung Jin; Kim, Young Ill; Chun, Ho-Kyung
- Issue Date
- Jul-2014
- Publisher
- 대한외과학회
- Keywords
- Natural orifice transluminal endoscopic surgery; Retroperitoneal approach; Total mesorectal excision; Inferior mesenteric artery
- Citation
- 대한외과학회지, v.87, no.1, pp 1 - 4
- Pages
- 4
- Journal Title
- 대한외과학회지
- Volume
- 87
- Number
- 1
- Start Page
- 1
- End Page
- 4
- URI
- https://scholarworks.bwise.kr/sch/handle/2021.sw.sch/12059
- DOI
- 10.4174/astr201487.1.1
- ISSN
- 2288-6575
2288-6796
- 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 DMA) 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.
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Collections - College of Medicine > Department of Internal Medicine > 1. Journal Articles
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