852 COMPARISON OF TRANSRECTAL AND TRANSVAGINAL HYBRID NATURAL ORIFICE TRANSLUMINAL ENDOSCOPIC SURGERY (NOTES) PARTIAL NEPHRECTOMY IN THE PORCINE MODEL

Abstract

You have accessJournal of UrologyTechnology & Instruments: Laparoscopy - Malignant Disease1 Apr 2012852 COMPARISON OF TRANSRECTAL AND TRANSVAGINAL HYBRID NATURAL ORIFICE TRANSLUMINAL ENDOSCOPIC SURGERY (NOTES) PARTIAL NEPHRECTOMY IN THE PORCINE MODEL Wassim M. Bazzi, Sean P. Stroup, Takayuki Dotai, Seth A. Cohen, Ryan P. Kopp, Omer Raheem, James Masterson, Suzanne Gudeman, Caroline Colangelo, Santiago Horgan, Christopher J. Kane, and Ithaar H. Derweesh Wassim M. BazziWassim M. Bazzi San Diego, CA More articles by this author , Sean P. StroupSean P. Stroup San Diego, CA More articles by this author , Takayuki DotaiTakayuki Dotai San Diego, CA More articles by this author , Seth A. CohenSeth A. Cohen San Diego, CA More articles by this author , Ryan P. KoppRyan P. Kopp San Diego, CA More articles by this author , Omer RaheemOmer Raheem San Diego, CA More articles by this author , James MastersonJames Masterson San Diego, CA More articles by this author , Suzanne GudemanSuzanne Gudeman San Diego, CA More articles by this author , Caroline ColangeloCaroline Colangelo San Diego, CA More articles by this author , Santiago HorganSantiago Horgan San Diego, CA More articles by this author , Christopher J. KaneChristopher J. Kane San Diego, CA More articles by this author , and Ithaar H. DerweeshIthaar H. Derweesh San Diego, CA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.944AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Transrectal Natural Orifice Transluminal Endoscopic Surgery (NOTES) nephrectomy has recently been performed in the porcine model. We compared feasibility of porcine Transrectal (TR) and Transvaginal (TV) hybrid NOTES partial nephrectomy (NOTES-PN). METHODS 8 female pigs (45 kg) underwent TR (n=4) or TV (n=4) NOTES-PN. In both pneumoperitoneum was created by periumbilical 12-mm trocar, through which a laparoscope was advanced for intra-abdominal visualization. For TV-NOTES-PN: A gastroscope (Olympus, Center Valley, PA) was used to obtain transvaginal peritoneal access. For TR-NOTES-PN: horizontal incision was made 2-cm above the dentate line and a submucosal tunnel was created in the posterior rectal wall. Gastroscope was advanced through the submucosal tunnel and retroperitoneum to the kidney. A peritoneal window was created. For both TR- and TV-NOTES-PN, the gastroscope was exchanged for the SPIDER System (TransEnterix, Morrisville, NC) TR, Figure 1). Flexible dissecting instruments and hook cautery introduced through the SPIDER arms were used to mobilize kidney (TR, Figure 2) and hilum. Periumbilical-introduced harmonic scalpel (Ethicon, Cincinnati, OH) and scissors were used to excise a portion of the lower pole. Lapra-Ty secured (Ethicon) sutured renorrhaphy was performed, followed by completion nephrectomy, TR or TV specimen extraction and rectotomy/vaginotomy closure. RESULTS TR-and TV-NOTES-PN was successfully performed in all 8 pigs. Comparison of TR and TV approaches revealed no significant difference in mean: access time (33.5 vs. 30.8 min, p=0.626), operative time (212.5 vs. 197.5 min, p=0.561), estimated blood loss (68.8 vs. 66.3 mL, p=0.943), and volume of resected specimen (p=0.763). Necropsy did not demonstrate abdominal injuries. CONCLUSIONS We demonstrate proof-of-principle for TR and TV-NOTES-PN in swine, with comparable perioperative parameters. Preclinical survival studies are requisite to assess potential of TR NOTES to be an alternative to TV. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e347 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Wassim M. Bazzi San Diego, CA More articles by this author Sean P. Stroup San Diego, CA More articles by this author Takayuki Dotai San Diego, CA More articles by this author Seth A. Cohen San Diego, CA More articles by this author Ryan P. Kopp San Diego, CA More articles by this author Omer Raheem San Diego, CA More articles by this author James Masterson San Diego, CA More articles by this author Suzanne Gudeman San Diego, CA More articles by this author Caroline Colangelo San Diego, CA More articles by this author Santiago Horgan San Diego, CA More articles by this author Christopher J. Kane San Diego, CA More articles by this author Ithaar H. Derweesh San Diego, CA More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...