title: New device for transrectal trocar placement and rectal sealing for NOTES: a porcine in vivo and human cadaver study.
abstract: To date, hybrid NOTES, combining transvaginal and laparoscopic access, represents the most popular clinically applied NOTES approach enabling surgical handling comparable to laparoscopic surgery. The transrectal route could be used in a similar way; however, suitable devices facilitating feasible transrectal access and rectal sealing are lacking.
  
  
  
  In collaboration with Karl Storz GmbH, we tailored a rectoscope and trocars to facilitate transrectal trocar placement and rectal sealing for hybrid NOTES procedures using rigid instruments. Five German Landrace pigs underwent transrectal hybrid NOTES cholecystectomy using the new devices. In a second experiment, the transferability to human anatomy was assessed in a human cadaver.
  
  
  
  Using the new devices, transrectal trocar placement and rectal sealing proved to be feasible in both experiments. Transrectal hybrid NOTES cholecystectomy could be performed without complications.
  
  
  
  The presented devices provide a tailored operating platform allowing precise transrectal trocar insertion and feasible sealing of the rectotomy. Consequently, these new instruments may pave the way for transrectal hybrid NOTES procedures and could succeed to clinical use in future.
authors.affiliation: Department of General, Visceral and Transplant Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.
authors.forename: Jonas D
authors.initials: JD
authors.lastname: Senft
authors.affiliation: Department of General, Visceral and Transplant Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.
authors.forename: Philip
authors.initials: P
authors.lastname: Gath
authors.affiliation: Department of General, Visceral and Transplant Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.
authors.forename: Tilman
authors.initials: T
authors.lastname: Dröscher
authors.affiliation: Department of General, Visceral and Transplant Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.
authors.forename: Philip C
authors.initials: PC
authors.lastname: Müller
authors.affiliation: Department of Internal Medicine I, Robert Bosch Hospital, Auerbachstrasse 110, 70376, Stuttgart, Germany.
authors.forename: Benedict
authors.initials: B
authors.lastname: Carstensen
authors.affiliation: Department of General, Visceral and Transplant Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.
authors.forename: Felix
authors.initials: F
authors.lastname: Nickel
authors.affiliation: Department of General, Visceral and Transplant Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.
authors.forename: Beat P
authors.initials: BP
authors.lastname: Müller-Stich
authors.affiliation: Department of General, Visceral and Transplant Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany. georg.linke@spitalstsag.ch.
authors.forename: Georg R
authors.initials: GR
authors.lastname: Linke
mesh_terms: D000818:Animals; D002102:Cadaver; D004867:Equipment Design; D006801:Humans; D010535:Laparoscopy / Q000295:instrumentation* / Q000379:methods; D008297:Male; D008953:Models, Anatomic; D057605:Natural Orifice Endoscopic Surgery / Q000295:instrumentation* / Q000379:methods; D012007:Rectum / Q000601:surgery*; D013525:Surgical Instruments; D034421:Sus scrofa; D013552:Swine; D058106:Wound Closure Techniques / Q000295:instrumentation
keywords: Endoscopy; Natural orifice translumenal endoscopic surgery (NOTES); Transanal; Transanal endoscopic microsurgery (TEM); Transrectal