Transrectal Intraperitoneal Assess With Transanal Endoscopic Operation (TEO) Device in Pig Model

Abstract

Gaining peritoneal access with subsequent safe closure is a prerequisite for natural orifice translumenal surgery (NOTES). We explored the possibility of transanal endoscopic operation (TEO) device to perform transrectal peritoneoscopy in a pig model. Performing transrectal peritoneoscopy with TEO device in pig model. Two pigs were used for transrectal peritoneoscopy. A 40-mm rectoscope was inserted via the anus after the induction of general anesthesia. Proctotomy was then created with diathermy and the endoscope was passed through the pararectal space into the peritoneal cavity. Proctotomy was closed with absorbable suture after completion of peritoneoscopy. Completion of the procedures was achieved in 2 pigs. Both pigs survived for more than 30 days. Necropsy revealed completely healed rectum with no evidence of leakage or abscess formation. Adhesions around the colostomy site were minimal. In conclusion, incorporation of TEO system is safe and useful in animal model for creation and closure of proctotomy for natural orifice translumenal surgery in transrectal access, further experiment should be performed to validate the possibility of application in human. Potential complications need to be addressed and well documented.