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首页> 外文期刊>Surgical Endoscopy >Transvaginal cholecystectomy without laparoscopic support using Prototype flexible endoscopic instruments in a porcine model
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Transvaginal cholecystectomy without laparoscopic support using Prototype flexible endoscopic instruments in a porcine model

机译：在猪模型中使用Prototype柔性内窥镜器械进行无腹腔镜支持的经阴道胆囊切除术

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Background: Transvaginal cholecystectomy with laparoscopic assistance has been performed safely in humans. The next goal was to develop a natural orifice transluminal endoscopic surgery (NOTES) technique to perform cholecystectomy without laparoscopic instruments using one flexible endoscope and flexible accessories. The aim of the study was to test the feasibility of the procedure in a survival porcine model. Methods: Cholecystectomies were attempted in five 88-130-lb. pigs with a planned 2-week survival. Prototype flexible instruments (NOTES Toolbox, Ethicon Endo-Surgery, Inc.) were used to aid in access, dissection, and removal of the gallbladder via the transvaginal route. Results Cholecystectomy could be completed without abdominal incision using prototype instruments in four out of five pigs. The cystic duct could be exposed with a flexible hook knife and clips applied. The steerable trocar improved stability and the precision of the dissection. The critical view was established in all five pigs. Dissection of the gallbladder off the liver bed was imprecise resulting in gallbladder perforation in all pigs and liver hemorrhage in two. At necropsy, all clips on the cystic duct were secure and no bile leak, bowel injury, or adhesions were present. Conclusions: NOTES cholecystectomy without laparoscopic support is feasible but challenging using prototype flexible endoscopic devices. A prototype clip applier was effective in controlling the cystic duct. Further improvements in instrument design to ensure precision and safety are needed before flexible devices should be used for pure NOTES procedures in humans.
机译：背景：经腹腔镜辅助的经阴道胆囊切除术已在人类中安全进行。下一个目标是开发一种自然孔口腔内镜手术（NOTES）技术，以使用一个柔性内窥镜和柔性附件在不使用腹腔镜器械的情况下执行胆囊切除术。这项研究的目的是测试该程序在生存猪模型中的可行性。方法：尝试在五个88-130磅的患者中进行胆囊切除术。计划2周生存的猪。使用原型柔性器械（NOTES Toolbox，Ethicon Endo-Surgery，Inc.）来帮助通过经阴道途径进入，解剖和清除胆囊。结果在五分之四的猪中，不用原型仪器就可以完成无胆囊切除术。胆囊管可以用挠性钩刀和夹子夹暴露。可操纵的套管针提高了解剖的稳定性和精确度。在所有五头猪中都建立了批判性观点。肝床胆囊解剖不精确导致所有猪胆囊穿孔，其中两只猪肝出血。尸检时，胆囊管上的所有夹子都牢固，没有胆漏，肠损伤或粘连。结论：NOTES在没有腹腔镜支持的情况下进行胆囊切除术是可行的，但是使用原型柔性内窥镜设备具有挑战性。原型施夹器可有效控制胆囊管。在将柔性设备用于人的纯NOTES程序之前，需要进一步改进仪器设计以确保精度和安全性。

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