title: Feasibility of transrectal hybrid natural orifice transluminal endoscopic surgery (NOTES) nephrectomy in the cadaveric model.
abstract: OBJECTIVE
  To examine feasibility of transrectal hybrid natural orifice transluminal endoscopic surgery (NOTES) nephrectomy in human cadavers in the evolution of this technique, as transrectal hybrid NOTES nephrectomy has been demonstrated in the porcine model.
  
  
  METHODS
  Four hybrid transrectal NOTES nephrectomies were performed on 4 cadavers (3 female/1 male, 2 right/2 left). Pneumoperitoneum was created by periumbilical 12-mm trocar, through which a laparoscope was advanced to obtain intra-abdominal visualization. A 4-cm horizontal incision was made 2-cm above the dentate line and a submucosal tunnel was created in the posterior rectal wall/presacral space. A dual-channel gastroscope was advanced through the submucosal tunnel and retroperitoneum to the level of the kidney using air insufflation. A peritoneal window was created and renal mobilization was completed. A transumbilically applied laparoscopic 45-mm stapler was used to transect the ureter and renal hilum. A specimen entrapment bag was deployed transrectally for specimen extraction, followed by transrectal incision closure.
  
  
  RESULTS
  Transrectal NOTES nephrectomy was successfully performed in all cases, with intact specimen extraction. Median weight was 77 kg (range 74-85 kg); median body mass index (BMI) was 30.1 kg/m(2) (range 25.6-31.2 kg/m(2)). Mean operative time was 175 minutes (range 150-210 minutes). Median transrectal access time was 36 minutes (range 24-47 minutes). Median dimensions of removed kidneys were length 11.2 cm (range 10-12 cm), width 5 cm (range 4.5-6 cm), and thickness 3.8 cm (range 3-4.5 cm).
  
  
  CONCLUSIONS
  Transrectal hybrid NOTES nephrectomy in the cadaver model is feasible with intact specimen extraction and acceptable operative times. Preclinical survival studies are requisite to assess sterility and complications. This approach may be an alternative to transvaginal access.
authors.affiliation: Department of Surgery/Division of Urology, University of California, San Diego School of Medicine, La Jolla, CA 92093-0987, USA.
authors.forename: Wassim M
authors.initials: WM
authors.lastname: Bazzi
authors.forename: Sean P
authors.initials: SP
authors.lastname: Stroup
authors.forename: Seth A
authors.initials: SA
authors.lastname: Cohen
authors.forename: Takayuki
authors.initials: T
authors.lastname: Dotai
authors.forename: Ryan P
authors.initials: RP
authors.lastname: Kopp
authors.forename: Caroline
authors.initials: C
authors.lastname: Colangelo
authors.forename: Omer A
authors.initials: OA
authors.lastname: Raheem
authors.forename: Sonia
authors.initials: S
authors.lastname: Ramamoorthy
authors.forename: Mark
authors.initials: M
authors.lastname: Talamini
authors.forename: Santiago
authors.initials: S
authors.lastname: Horgan
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Kane
authors.forename: Ithaar H
authors.initials: IH
authors.lastname: Derweesh
mesh_terms: D002102:Cadaver; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D057605:Natural Orifice Endoscopic Surgery / Q000379:methods*; D009392:Nephrectomy / Q000379:methods*; D012007:Rectum