Page 22 - World Journal of Laparoscopic Surgery

S Abbas, R Rizvi

endoscopes into the abdomen. A group from the University instruments. The patient, reportedly recovered well after
of California-San Diego has performed complex small bowel this procedure without complications. Many series of hybrid
resections by inserting endoscopes and staplers through cholecystectomy, using a variety of techniques, have been
both stomach and rectum. 12,26 Although these procedures publicized at international surgery and gastroenterology
were done under laparoscopic supervision, but the same meetings.
dual scope technique might be applied to pure NOTES cases. The Ohio State group performed the first institutional
Recently, NOTES sigmoid colectomy has been review board-approved series of hybrid transgastric
33
performed in human cadavers without a flexible endoscope. peritoneoscopy. NOTES peritoneoscopy was performed
Swanstrom used transanal endoscopic microsurgery in all patients with suspected adenocarcinoma of head of
27
techniques to perform a radical sigmoid colectomy. with the pancreas. An initial diagnostic laparoscopy was
high ligation of the vessels and generous lymphadenectomy. performed followed by the creation of an anterior gastrotomy
There are only few reports in the literature of human and transgastric peritoneoscopy under laparoscopic
transluminal cholecystectomy, all of them using the supervision. In most of the cases, NOTES abdominal
transvaginal route. exploration was found to be equivalent to laparoscopy in
detecting peritoneal metastases. There were no complications
CLINICAL NOTES directly related to the transgastric procedure. Thus the
authors concluded that transgastric peritoneoscopy in
Although one can suggest that natural orifice surgery has
humans is feasible and safe.
been practiced for years as translumenal drainage of
The first case of pure NOTES published from the United
28
pancreatic pseudocysts and transgastric pancreatic States was conducted at case Western Reserve University,
29
debridement are considered standard procedures for many 34
Cleveland. A PEG tube placed for nutritional support was
advanced endoscopists. Culdoscopy, a procedure in which
dislodged three days after its initial placement and as the
a laparoscope is inserted into the abdomen through the
stomach had not yet adhered to the anterior gastric wall,
vagina, is commonly used in the management of infertility
therefore there was a free communication between the
and tubal ligation. Some even might even suggest that
gastric lumen and the abdomen. The abdominal exploration
percutaneous endoscopic gastrostomy, first described in and irrigation was done, and the gastrostomy tube was
30
1979, was the first endoscopic procedure that purposely
restored using pure NOTES techniques. To retrieve the PEG
breached the gastric lumen and supplanted a standard
without laparotomy or laparoscopy, a gastroscope was
operation, thus qualifying as NOTES. advanced into the stomach, the prior gastrotomy site was
The first reported case of actual natural orifice surgery dilated with a balloon and the endoscope advanced into the
was performed nearly a decade ago by a surgeon in the abdominal cavity. Some soilage was identified, which was
United States. A hybrid of laparoscopic/endoscopic cleansed using the endoscopic irrigation channel. The original
cholecystectomy was undertaken. Needlescopic instruments abdominal incision was used to pass a wire into the
were used and laparoscopic cholecystectomy was done peritoneal cavity, and the PEG was retrieved using the pull
using standard techniques, however, for the retrieval of technique. After the “PEG Rescue” the patient recovery
gallbladder anterior gastrotomy was made and the specimen was uneventful.
was placed into the stomach and removed by mouth with The first true translumenal cholecystectomy was
the endoscope. The gastrotomy was then closed using reported by Marescaux and colleagues from Strasbourg,
intracorporeal suturing techniques. France. 35 The transvaginal route was used to access the
After this first unpublished hybrid case, natural orifice abdomen in a 30-year-old woman with symptomatic
techniques were largely ignored until Kalloo’s 2004 cholelithiasis. A 2 mm needle port was used for insufflation
publication. After the successes of the Apollo group with and monitoring of intra-abdominal pressure. The
laboratory notes, a group in India performed a series of cholecystectomy was performed without the aid of a
transgastric appendectomies and transgastric tubal ligations. laparoscope using only NOTES techniques. The patient’s
Although unpublished, the videos have been widely recovery was uneventful.
circulated. The Columbia group in New York City
NOTES: WHOSE DOMAIN IS IT ANYWAY?
performed a hybrid cholecystectomy with extraction of the
specimen through the vagina. 31,32 Dissection and retraction The question arises as to whether surgeons or gastro-
were performed with both the laparoscopic and endoscopic enterologists will be the primary operators of NOTES. 36,37

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JAYPEE