Evaluation for transvaginal and transgastric NOTES cholecystectomy in human and animal natural orifice translumenal endoscopic surgery.
OBJECTIVE
Natural orifice translumenal endoscopic surgery (NOTES) is a novel concept using an endoscope via a translumenal access for abdominal surgery. This study was designed to evaluate the feasibility and technical aspects of NOTES cholecystectomy from our experience on humans and animals.


METHODS
NOTES cholecystectomies were performed in 12 animal experiments, including 8 pigs (6 by transgastric and 2 by transvaginal accesses) and 4 dogs (4 transvaginal accesses), and a human female cadaver.


RESULTS
The entire gallbladder could be removed under direct vision in all experiments. The average time was 60 min by transgastric and 40 min by transvaginal in animals. It was 87 min for human transvaginal cholecystectomy. In all animal and human procedures, there was no major complication concerning the operation.


CONCLUSIONS
The transvaginal route may be the easiest route for abdominal NOTES. Percutaneous endoscopic gastrostomy (PEG) allowed the safe performance of a controlled gastric perforation and shortened the time. The hybrid method allowed performance of a safe procedure and shortened the time.


CONCLUSIONS
Transvaginal and transgastric NOTES cholecystectomy is technically feasible and safe in both humans and animals. New instrumentation needs to be developed to perform a pure NOTES cholecystectomy without transabdominal assistance.
Sugimoto
Maki
M
Department of Surgery, Teikyo University Chiba Medical Center, 3426-3 Anesaki, Ichihara, Chiba, 299-0111, Japan. sugimototeikyo@gmail.com
Yasuda
Hideki
H
Koda
Keiji
K
Suzuki
Masato
M
Yamazaki
Masato
M
Tezuka
Tohru
T
Kosugi
Chihiro
C
Higuchi
Ryota
R
Watayo
Yoshihisa
Y
Yagawa
Yohsuke
Y
Uemura
Shuichiro
S
Tsuchiya
Hironori
H
Hirano
Atsushi
A
Ro
Shoki
S
D000818:Animals; D002102:Cadaver; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects / Q000379:methods*; D002921:Cicatrix / Q000517:prevention & control; D004195:Disease Models, Animal; D004285:Dogs; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D020706:Laparoscopes; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D012307:Risk Factors; D013270:Stomach; D013552:Swine; D016896:Treatment Outcome; D014621:Vagina