Transgastric cecectomy in canine models: natural orifice transluminal endoscopic surgery (NOTES).
BACKGROUND
Natural orifice transluminal endoscopic surgery (NOTES) for bowel resection is a challenging procedure. We studied the feasibility and safety of NOTES by performing cecectomy in dogs, which is equivalent to simple bowel resection in man.


METHODS
Three dogs underwent transgastric endoscopic cecectomy with laparoscopic assistance. Antibiotics and irrigation were administered as preoperative preparation. A single-channel endoscope was introduced through the stomach into the peritoneal cavity, and the cecum was dissected and ligated with an L-knife and endoloops, respectively. Laboratory blood testing, peritoneal bacterial culture, and radiologic testing were performed perioperatively. Animals underwent autopsies on postoperative day (POD) 14.


RESULTS
All subjects survived surgery and remained alive until POD 14. Mean operative time was 126.6 min. The absence of bacterial infections and anatomic leaks was verified by peritoneal swap culture, blood count, air leak testing, and bowel contrast radiology. However, a temporary mild elevation in white blood cell count was noted. No abscess or sign of infection was observed during autopsy, although adhesion was evident.


CONCLUSIONS
Transgastric endoscopic cecectomy with minimal laparoscopic assistance is a feasible and safe procedure. Cecectomy in dogs is equivalent to procedures such as appendectomy, resection of Meckel's diverticulum, and oophorectomy in man. Natural orifice transluminal endoscopic surgery could prove to be a good optional surgical procedure.
Lee
Sang-Il
SI
Department of Surgery, Chungnam National University School of Medicine, 33 Munhwa-ro, Jung-gu, Daejeon, 301-721, Korea.
Park
Jong-Hyun
JH
Park
Chi-Woo
CW
Kim
Young-Ill
YI
Jeong
Seong-Mok
SM
Kim
Ji-Yeon
JY
D000818:Animals; D002432:Cecum / Q000601:surgery*; D004285:Dogs; D005260:Female; D023421:Models, Animal; D057605:Natural Orifice Endoscopic Surgery / Q000295:instrumentation / Q000379:methods; D013270:Stomach