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首页> 外文期刊>Urology >Embryonic natural orifice transumbilical endoscopic surgery (E-NOTES) for advanced reconstruction: initial experience.
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Embryonic natural orifice transumbilical endoscopic surgery (E-NOTES) for advanced reconstruction: initial experience.

机译：胚胎自然孔经脐内镜手术（E-NOTES）进行高级重建：初步经验。

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OBJECTIVES: Natural orifice transluminal endoscopic surgery comprises intraabdominal surgery performed by way of natural orifices (ie, vagina, mouth). In a similar manner, the umbilicus provides an embryonic natural orifice that permits intraabdominal access. We report on the feasibility of performing single-port advanced laparoscopic reconstructive surgery by way of the umbilicus in 6 patients. We propose the terminology embryonic-natural orifice transluminal endoscopic surgery (E-NOTES) for this novel surgical approach. METHODS: Through a single 1.5- to 3-cm intraumbilical incision and a novel, single-access port, we performed laparoscopic bilateral single-session Anderson-Hynes pyeloplasty (2 patients, 4 procedures), ileal ureter (n = 1), and ureteroneocystostomy with a psoas hitch (n = 1). No extraumbilical skin incisions were used. A 2-mm Veress needle port, inserted through a skin needle puncture, was used to create the pneumoperitoneum and to selectively insert a needlescopic grasper to assist in suturing. RESULTS: All procedures were successful without the need for any additional laparoscopic ports. For the 2 patients undergoing bilateral pyeloplasty (including patient repositioning) and the 1 patient each undergoing ileal ureter and psoas-hitch ureteroneocystostomy, the operating time was 4.5, 6, 5, and 3 hours, blood loss was 100, 50, 75, and 50 mL, and the hospital stay was 1, 2, 3, and 2 days, respectively. No intraoperative or postoperative complications developed. CONCLUSIONS: To our knowledge, we present the initial experience with advanced laparoscopic reconstruction through a single intraumbilical port. Additional refinement of this technology could lead to wider incorporation of single-port laparoscopy in clinical practice. Embryonic-natural orifice transluminal endoscopic surgery appears to be a promising new approach for select indications.
机译：目的：自然孔腔内镜手术包括通过自然孔（即阴道，口）进行的腹腔内手术。以类似的方式，脐带提供了允许腹部内进入的胚胎天然孔。我们报告了通过脐带在6例患者中进行单端口高级腹腔镜重建手术的可行性。我们为这种新颖的手术方法提出了术语“胚胎天然孔腔内镜手术”（E-NOTES）。方法：通过一个1.5至3 cm的脐带内切口和一个新颖的单通路，我们进行了腹腔镜双侧单次安德森-海恩斯肾盂成形术（2例患者，4个步骤），回肠输尿管（n = 1），以及带腰大肌结的输尿管膀胱造口术（n = 1）。没有使用脐外皮肤切口。通过皮肤针穿刺插入的2毫米Veress针孔用于产生气腹，并选择性地插入针镜抓取器以辅助缝合。结果：所有手术均成功，无需任何其他腹腔镜端口。对于2例接受双侧肾盂成形术（包括患者重新定位）的患者和1例分别接受回肠输尿管和腰大腿结扎输尿管膀胱造瘘术的患者，手术时间分别为4.5、6、5和3小时，失血量分别为100、50、75和50 mL，住院时间分别为1、2、3和2天。没有发生术中或术后并发症。结论：据我们所知，我们介绍了通过单个脐带内端口进行高级腹腔镜重建的初步经验。对该技术的进一步完善可能导致单端口腹腔镜在临床实践中的广泛应用。胚胎自然孔腔内镜手术似乎是选择适应症的一种有前途的新方法。

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