title: Snake charmer NOTES: a two-luminal access for hybrid NOS operations.
abstract: Despite recent advances in NOTES, NOS, SILS and related techniques, the feasibility of performing extensive surgery is still limited. Colon surgery usually requires additional access sites or complex technical means for triangulation and retraction. A method is presented that enables single-port colon surgery, supported by flexible colonoscopy. Single-port sigmoidectomy was performed in five cases on the porcine model. Flexible colonoscopy was used to manoeuvre the colon and expose its mesentery for dissection. The specimen was retrieved transrectally by invagination. Single-port sigmoidectomy supported by colonoscopy was feasible in all cases. The method provided a fixed framework, excellent organ guidance and exposition of the mesentery and enabled bowel-close mesocolic preparation. The access angle for preparation and visualisation could be altered during the procedure using the colonoscope. During autopsy on day 21, competent anastomotic healing with only rare interenteric adhesions was observed. One animal had a small preperitoneal abscess in the umbilical region while demonstrating completed skin healing. Flexible colonoscopy provided a fixed reference frame that enabled single-port preparation and dissection of the sigmoid colon. Under colonoscopic guidance, the access angle for dissection could be adapted according to the surgeon's needs. The procedures could be performed safely and effectively.
authors.affiliation: Department of Surgery, Robert-Bosch-Krankenhaus, Stuttgart, Germany. wolfram.lamade@rbk.de
authors.forename: Wolfram
authors.initials: W
authors.lastname: Lamadé
authors.forename: Fabian
authors.initials: F
authors.lastname: Rieber
authors.forename: Peter
authors.initials: P
authors.lastname: Köhler
authors.forename: Colin
authors.initials: C
authors.lastname: Friedrich
authors.forename: Mike
authors.initials: M
authors.lastname: Diederich
authors.forename: Tarkan
authors.initials: T
authors.lastname: Basar
authors.forename: Christoph
authors.initials: C
authors.lastname: Ulmer
authors.forename: Klaus Peter
authors.initials: KP
authors.lastname: Thon
authors.forename: Jörn
authors.initials: J
authors.lastname: Bernhardt
mesh_terms: D000818:Animals; D003082:Colectomy / Q000379:methods; D012809:Colon, Sigmoid / Q000601:surgery*; D003113:Colonoscopy / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D057605:Natural Orifice Endoscopic Surgery / Q000379:methods*; D013552:Swine