BACKGROUND: Prior studies demonstrate the feasibility of NOTES organ resection. Aim of this study was to develop an endoscopic minimally-invasive resection of the kidney. METHODS: Using an endoscopic transgastric (N=2) and transvaginal (N=4) approach, resection of the kidney was performed in the porcine animal model. RESULTS: Six female swine underwent endoscopy with a double-channel gastroscope. In two animals, a gastric incision was performed using a needle knife at the anterior wall of the stomach. The left kidney was mobilized, renal artery, vein and ureter were clipped endoscopically, and then dissected. The organ was retrieved through an 8 cm abdominal incision. The gastric incision was closed with clips. Both animals undergoing ETGN were sacrificed after the procedure. In one of the four animals with transvaginal access, a rigid 12.5 mm trocar was used. In the other three ETVN experiments, the needle knife was used to obtain access through the posterior vagina at a distance of 20 cm from the vaginal orifice. Using this port, the kidney was resected endoscopically and was cut into 6-9 pieces with a polypectomy snare. The kidney was removed piece-by-piece through the vagina using a retrieval net. An endoscopic closure of the vaginal incision was obviated. While dissecting the hilus of the kidney, an uncontrollable bleeding occurred in one animal. The animal had to be sacrificed prematurely. Another procedure had to be aborted due to irresolvable technical malfunction of the endoscope processor. Two animals were survived for 19 days and 40 days. There were no clinical signs of intra-abdominal infection. CONCLUSIONS: We could demonstrate the technical feasibility of NOTES nephrectomy. The transvaginal approach without closure was well tolerated by the survival animals.
Program Number: P218