Cholecystectomy via natural orifice transluminal endoscopic surgery

Abstract

Objective To evaluate the feasibility and relative merits of cholecystectomy via natural orifice transluminal endoscopic surgery （NOTES） in porcine model. Methods A total of 8 female pigs were divided into 4 groups to accept cholecystectomy via different NOTES approaches, which included single transvaginal dual-channel endoscopy, combination of trans-vaginal dual-channel endoscopy and trans-gastrie conventional endoscopy, laparoseopy assisted trans-vaginal dual-channel endoscopy, and single trans-vaginal dual-channel endoscopy with cap. An incision in the vaginal wall was made with a needle-knife, expanded with a cutting knife and enlarged with a dilating balloon, after which a dual-channel endoscope was advanced into the peritoneal cavity to locate and excise the gallbladder. The incision was closed with clips. Animals were sacrificed 1 week later to explore the changes in peritoneal cavity, including adhesion, injuries around the gallbladder and healing situation of the incisions. Results Cholecystectomy could not be accomplished with single endoscope technique, but was succeeded in 1 animal with combination technique and laparoscopy assisted technique, respectively, and was performed successfully in 2 pigs with cap assisted methods. Rupture of gallbladder occurred in combination group and bleeding occurred in laparoscnpy assisted group. Conclu- sion Cholecystectomy via NOTES is feasible, and cap assisted dual-channel endoscope with EMR-cap is the most desirable NOTES technique. Development of specialized instruments is the key of success. Key words: Endoscopic surgical procedures; Swine; Natural orifice transluminal endoscopicsurgery; Transgastric approach ; Transvaginal approach ; cholecystectomy