Laparoscopic- Assisted Endoluminal Surgery: a Steping Stone to NOTES

Background:
As Natural Orifice Transluminal Endoscopic Surgery (NOTES) approaches on the horizon, surgeons will need to develop the fundamental skills and spatial orientation needed to perform in this new perspective. The Natural Orifice Surgery Consortium for Assessment and Research (NOSCAR) has established several fundamental challenges to the safe introduction of NOTES. Our institutional experience with laparoscopic assisted endoluminal surgery is reviewed to display the techniques and efficacy of procedures that may provide a safe transition to NOTES.

Methods:
A retrospective review of all laparoscopic assisted endoluminal surgeries from 1991 to 2007 was performed. All procedures involved establishment of pneumoperitoneum, placement of endoluminal balloon trochar ports under laparoscopic and endoscopic visualization, intraluminal insufflation, coordinated resection of intraluminal pathology using both the endoscope and laparoscopic instruments, and closure of the intraluminal port sites with intracorporeal suturing.

Results:
A total of 177 procedures were performed from 1991 to 2007 using these techniques. These procedures varied and included laparoscopic monitored colon polypectomy, resection of gastric polyps, intraluminal cystgastrostomy, gastric ulcer resection, foreign body removal, and extraction of colon specimen through the vagina. The average age was 55 years ( range 38-75), length of operation 95 minutes (range 60-137), hospital stay 3.5 days and 1 complication (2.8%).

Conclusions:
Our institutional experience with these procedures successfully displays a safe and effective approach to a wide range of intraluminal pathology. While patients benefit from a shorter hospital stay, less post-operative pain, improved cosmesis and less morbidity, the laparoscopic surgeon can perform these operations using current instruments and equipment to safely transition into the emerging field of NOTES.


Session: Podium Presentation

Program Number: S061

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