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Transanal endoscopic microsurgical platform for natural orifice surgery

Background The excitement surrounding natural orifice transluminal endoscopic surgery (NOTES) remains tempered by concerns over safe access and closure of transvisceral enterotomies. Research in NOTES has commonly been described as using an oral transgastric access point. Transanal endoscopic micros...

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Bibliographic Details
Published in:Gastrointestinal endoscopy 2008-11, Vol.68 (5), p.954-959
Main Authors: Denk, Peter M., MD, Swanström, Lee L., MD, Whiteford, Mark H., MD
Format: Article
Language:English
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Summary:Background The excitement surrounding natural orifice transluminal endoscopic surgery (NOTES) remains tempered by concerns over safe access and closure of transvisceral enterotomies. Research in NOTES has commonly been described as using an oral transgastric access point. Transanal endoscopic microsurgery (TEM) is a minimally invasive technique for a full-thickness resection of rectal tumors and with suture closure of the resultant defect with highly specialized instruments. This technique has been used clinically in human beings for more than 2 decades. Entry into the peritoneal cavity during a resection of rectosigmoid lesions has been described, and safe closure can be obtained. Objective To assess the feasibility of transrectal NOTES procedures by using TEM instrumentation. Design Three porcine and 3 human cadaver models were studied by using standard TEM instrumentation and flexible endoscopes. NOTES peritoneal access, a peritoneoscopy, a liver biopsy, and colorectal resections were performed. Results True NOTES procedures facilitated with TEM instrumentation were successfully completed. Limitations This was a preclinical study, and several challenges to bridging to human clinical use exist: TEM instruments are currently designed for intraluminal tasks low in the pelvis, with 5-mm to 10-mm port sizes; the cost of the TEM instruments and insufflation system; and the learning curve to perform TEM closure. Conclusions Our preclinical study demonstrated the feasibility of several transrectal NOTES procedures, colorectal resection, and anastomosis when using TEM instrumentation. We, therefore, suggest TEM as a portal for NOTES.
ISSN:0016-5107
1097-6779
DOI:10.1016/j.gie.2008.03.1115