title: [Accessibility of peritoneal organs according to the routes of approach in NOTES].
abstract: OBJECTIVE
  Natural orifice transluminal endoscopic surgery (NOTES) is a new era of minimally invasive surgery which has the potential to offer scarless surgery. So far, numerous reports on various routes to peritoneal organs in NOTES have been published. In case of transgastric approach, it is more inconvenient than transcolonic approach to access upper abdominal organs because of retroflexion. However, most data were subjective and there was no report examining the best access route for the exploration of peritoneal organs. The aim of this study was to evaluate the best access route according to the abdominal organs objectively.
  
  
  METHODS
  Six female pigs weighing 30 to 35 kg were placed under general anesthesia. Incisions were made on both anterior wall of stomach body and rectosigmoid colon 15 to 20 cm above anal verge, respectively. Then, via each incision site, we evaluated the endoscopic visibility and checked the elapsed time to access abdominal organs in sequence [(gallbladder (GB), spleen, bladder, uterus, and ovary)].
  
  
  RESULTS
  On comparison of the mean time to approach each organs, GB and ovary showed statistical difference in the mean time to approach between transgastric and transcolonic approaches. It took relatively shorter time to access GB via transcolonic route than transgastric route (352.3+/-80.1 sec vs. 222.2+/-82.0 sec, p=0.021). Next, we evaluated the time to access upper organs (GB and spleen) and lower organs (bladder, uterus and ovary). In case of lower organs, it showed no difference in time between transgastric and transcolonic approaches. However, to explore upper organs, transcolonic route was more favorable than transgastric route (351.8+/-80.7 sec vs. 273.3+/-110.3 sec, p=0.002).
  
  
  CONCLUSIONS
  For exploration of lower organs, there is statistically no significant difference in time between transgastric and transcolonic approaches. But, in case of upper organs, transcolonic approach is superior to transgastric approach.
authors.affiliation: Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea.
authors.forename: Chul Young
authors.initials: CY
authors.lastname: Kim
authors.forename: Hoon Jai
authors.initials: HJ
authors.lastname: Chun
authors.forename: Ju Young
authors.initials: JY
authors.lastname: Kim
authors.forename: Jin Su
authors.initials: JS
authors.lastname: Jang
authors.forename: Yong Dae
authors.initials: YD
authors.lastname: Kwon
authors.forename: Sanghoon
authors.initials: S
authors.lastname: Park
authors.forename: Bora
authors.initials: B
authors.lastname: Keum
authors.forename: Yeon Seok
authors.initials: YS
authors.lastname: Seo
authors.forename: Yong Sik
authors.initials: YS
authors.lastname: Kim
authors.forename: Yoon Tae
authors.initials: YT
authors.lastname: Jeen
authors.forename: Hong Sik
authors.initials: HS
authors.lastname: Lee
authors.forename: Soon Ho
authors.initials: SH
authors.lastname: Um
authors.forename: Sang Woo
authors.initials: SW
authors.lastname: Lee
authors.forename: Jai Hyun
authors.initials: JH
authors.lastname: Choi
authors.forename: Chang Duk
authors.initials: CD
authors.lastname: Kim
authors.forename: Ho Sang
authors.initials: HS
authors.lastname: Ryu
mesh_terms: D000818:Animals; D005240:Feasibility Studies; D005260:Female; D010535:Laparoscopy; D019060:Minimally Invasive Surgical Procedures; D023421:Models, Animal; D010529:Peritoneal Cavity / Q000601:surgery*; D018709:Statistics, Nonparametric; D013552:Swine; D013995:Time