Horn Resection Research Articles

Su1589 Transgastric NOTES® Surgery is Well Tolerated and Induces a Decreased Postoperative Stress Response in a Pig Uterine Horn Resection Model

Su1589 Transgastric NOTES® Surgery is Well Tolerated and Induces a Decreased Postoperative Stress Response in a Pig Uterine Horn Resection Model

Absorbable ligation loops for flexible endoscopy: a necessary tool for natural orifice transluminal endoscopic surgery

One of the main challenges of natural orifice transluminal endoscopic surgery (NOTES) remains the development of safe and reliable tools. In this study, we introduce the first absorbable ligatures specifically designed for NOTES. To determine the feasibility of a new absorbable ligation loop (NOTES loop) and to compare this new type of suture with the nonabsorbable loop (Endoloop) most commonly used until now. Prospective, comparative animal trial/survival animal study (observation period 21 days) with subsequent histopathological assessment (blinded observer design). Veterinarian center. This study used 12 female domestic piglets. Every pig underwent two transgastric uterine horn ligations, one with an absorbable loop and one with a nonabsorbable loop. Additional uterine horn resections on both sides were done on 6 pigs. Intervention success, loop reliability, foreign-body reaction, extent of inflammatory response (μm). Transgastric flexible intra-abdominal ligation of the uterine horns was performed safely with both loops in all cases. During a 3-week observation period, 11 of 11 NOTES loops and 10 of 11 Endoloops were reliable. Microscopically, foreign-body reaction was minimal around both sutures (P = .303). The overall inflammatory response was larger around the Endoloops (P = .046). Uterine horn resection had an influence on the extent of inflammation. Animal study. Ligation was feasible with both loops. The absorbable loops were reliable during a 3-week observation period and can be recommended for use during NOTES appendectomies.

The Development and Testing of An Adaptable Minimally-Invasive Surgical Platform - The Hydra

Introduction: Progress has been made in developing new platforms for NOTES, but limitations in stability, instrumentation, navigation, closure, and triangulation, as identified by NOSCAR, remain to be addressed. Interest in less-invasive surgery beyond laparoscopy has also expanded beyond NOTES into approaches such as Single Site Laparoscopy (SSL), enabled by both rigid and flexible instruments. New platforms, capable of adaptation to a range of developing surgical approaches, seem necessary. Methods: Clinicians and engineers partnered together to develop a new platform, the Hydra, which is adaptable to transgastric and transvaginal hybrid/pure NOTES approaches, as well as SSL. The foundation of the platform is a multi-directional Steerable Flexible Trocar (15 mm internal diameter) that allows navigation to the targeted area. The Trocar is passed into the peritoneal cavity via a needle knife/balloon; through it, an operative tool with three 4mm channels is advanced. Two of these channels articulate independently in multiple directions, allowing triangulation. The third channel carries a unique 3.7 mm, joystick-controlled, endoscope (Karl Storz EndoVision, Charlton, MA) that can be elevated over the articulating channels, providing a view independent of the operative tools. The system is controlled by a laparoscopy-like interface that allows a surgeon to use 2 hands to manipulate at least 2 tools with degrees of freedom not available in conventional endoscopes. Changes in system length and flexibility can be made to accommodate a variety of surgical approaches. Additional tools under development include a range of flexible staplers, next-generation closure, and remote retraction. The entire Toolbox of NOTES devices, including Bela bipolar forceps, a clip applier, flexible Marylands, etc., is compatible with the Hydra. Results: The Hydra has been used in a series of 8 acute porcine labs via transgastric and transvaginal approaches. Pure NOTES uterine horn resection and hybrid cholecystectomy are feasible. The elevated view from the Storz camera has eliminated the need for laparoscopic vision. A wide variety of surgical interventions, including dissection, ligation, and retrieval have been demonstrated. The control interface, coupled with stiffness in the system, provides for a stable operating platform. Further improvements are necessary in targeting, tissue manipulation, and system robustness. Conclusions: The Hydra provides the foundation for development of a new generation of minimally-invasive surgical instrumentation. Its straightforward design, complemented by NOTES Toolbox 1.0, is amenable to application in a range of approaches.

Adhesion formation after uterine horn resection in rabbit model: comparative study of laparoscopic procedure vs. laparotomy

ABSTRACTObjective To determine whether laparoscopic surgery causes less adhesion formation than standard laparotomy for uterine horn resection in the rabbit model.Design Experimental prospective animal study: 10 New Zealand female rabbits were randomly allocated to operation by laparoscopy and 10 to standard laparotomy for uterine horn resection.Setting Tertiary referral centre for laparoscopic surgery.Interventions Laparoscopy and laparotomy.Main outcome measures Blauer's adhesions score, fibrous tissue layers and mesothelium layers at the site of the lesion.Results The median Blauer score was 1.0 in the laparoscopy group and 2.5 in the laparotomy group (P = 0.0003). The median number of layers of the area of fibrous tissue was 20 in the animals submitted to laparoscopy, and 65 in those submitted to laparotomy (P < 0.0001). The median number of layers of mesothelium was 1 in the laparoscopy group and 4 in the laparotomy group (P < 0.0001).Conclusion Laparoscopy caused less postoperative adhesion than laparotomy. Rabbits subjected to laparotomy presented a greater degree of mesothelial hyperplasia and more formation of fibrous tissue than the animals subjected to laparoscopy.

Laparoscopic extirpation of bilateral rudimentary horns in a patient with a variant of Mayer-Rokitansky-Kuster-Hauser syndrome

Objective To report a case of laparoscopic resection of bilateral rudimentary horns in a patient with a variant of Mayer–Rokitansky–Kuster–Hauser (MRKH) syndrome. Methods The clinical records of the patient were reviewed. Results Laparoscopy was undertaken in our patient for diagnosis of suspicious adnexal masses which had been observed on ultrasound examination. Laparoscopy disclosed two Müllerian remnants (bilateral rudimentary horns) on each pelvic sidewall and a simple paraovarian cyst 3–4 cm in size. These remnants did not communicate with each other and cervical agenesis was identified. It was decided to undertake bilateral laparoscopic horn resection since our patient complained of a cyclic pelvic pain and suspicious endometriotic implants on the right ovary and fallopian tube were observed; this was performed without complication. The resected horns and paraovarian cyst were removed by use of an endobag with extension of the left 5-mm trocar incision. The patient was completely free of symptoms at the 1- and 6-months follow-up examinations. Conclusion Laparoscopic resection was used safely for the treatment of a variant of MRKH syndrome with bilateral rudimentary horns.