title: Pure Natural Orifice Transluminal Endoscopic Surgery (NOTES) with a new elongated, curved Transanal Endoscopic Operation (TEO) device for rectosigmoid resection: a survival study in a porcine model.
abstract: BACKGROUND
  Natural orifice transluminal endoscopic surgery (NOTES) has seen considerable new developments in its evolution to a platform for rectal and sigmoid resection, but to date no true single NOTES procedure has been convincing. This study investigates the safety and feasibility of a further developed transanal NOTES platform for single-access NOTES rectosigmoid resection.
  
  
  METHODS
  Ten large female pigs, mean weight 99.3 kg [standard deviation (SD) 7 kg, range 85.1-112.6 kg], underwent transanal rectosigmoid resection. Five animals were included in an acute study group with immediate postoperative euthanization. A second group included five animals in a survival study. Transanal rectosigmoid resections were performed with an elongated and curved transanal endoscopic operation (TEO) device. Coloanal anastomosis was performed using the transanal circular stapler technique. Survival follow-up was at 7 and 28 days via colonoscopy under sedation.
  
  
  RESULTS
  Single-access NOTES transanal rectosigmoid resection with coloanal anastomosis was performed in nine out of ten female pigs. Mean length of rectosigmoid specimens exteriorized was 18.7 cm (SD 2.9 cm, range 14-23 cm). Mean operating time was 124 min (SD 35.7 min, range 70-166 min). Within the survival group, no complications occurred during the monitoring phase. In one case, there was ascites and colitis at necropsy as well as fibrosis at the anastomosis site.
  
  
  CONCLUSIONS
  Pure transanal rectosigmoid resection is a feasible procedure. The approach via a single transanal access is demanding but viable with the elongated and curved TEO device. The newly developed scope offers an excellent view of the area cephalad to the promontory.
authors.affiliation: Department of General, Visceral and Transplant Surgery, Tübingen University Hospital, Hoppe-Seyler-Strasse 3, 72076, Tübingen, Germany.
authors.forename: P
authors.initials: P
authors.lastname: Wilhelm
authors.affiliation: Department of General, Visceral and Transplant Surgery, Tübingen University Hospital, Hoppe-Seyler-Strasse 3, 72076, Tübingen, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Axt
authors.affiliation: Department of General, Visceral and Transplant Surgery, Tübingen University Hospital, Hoppe-Seyler-Strasse 3, 72076, Tübingen, Germany.
authors.forename: P
authors.initials: P
authors.lastname: Storz
authors.affiliation: Department of Pathology, Tübingen University Hospital, Tübingen, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Wenz
authors.affiliation: Department of General, Visceral and Transplant Surgery, Tübingen University Hospital, Hoppe-Seyler-Strasse 3, 72076, Tübingen, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Müller
authors.affiliation: Department of General, Visceral and Transplant Surgery, Tübingen University Hospital, Hoppe-Seyler-Strasse 3, 72076, Tübingen, Germany. akirschniak@aol.com.
authors.forename: A
authors.initials: A
authors.lastname: Kirschniak
mesh_terms: D000818:Animals; D012809:Colon, Sigmoid / Q000601:surgery*; D003113:Colonoscopy / Q000295:instrumentation* / Q000379:methods; D003125:Colostomy / Q000379:methods; D020776:Endoscopes, Gastrointestinal; D005240:Feasibility Studies; D005260:Female; D023421:Models, Animal; D057605:Natural Orifice Endoscopic Surgery / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D061646:Operative Time; D012007:Rectum / Q000601:surgery*; D013552:Swine
keywords: NOTES; Natural orifice; Rectosigmoid resection; TEO; Transanal