Hybrid Transvaginal Sleeve Gastrectomy in a Porcine Model.
INTRODUCTION – The authors describe the first transvaginal sleeve gastrectomy with an additional trocar in umbilicus in a porcine model. Our purpose is prove that bariatric procedures can be realized by NOTES (Natural Orifice Translumenal Endoscopic Surgery). METHODS AND PROCEDURES – A female pig with 50 pounds was underwent to a general anesthesia. Pneumoperitoneum and… Continue Reading
- Type:
- Posters
- Topic:
- Endolumenal / NOTES
Impact of Transoral Incisionless Fundoplication Fasteners on Lower Esophageal Sphincter Anatomy & Physiology: A Balancing Act
INTRODUCTION: Transoral incisionless fundoplication (TIF) may have improved outcomes over simple, single shot, endoscopic therapy because it allows the surgeon to tailor the fundoplication to the gastro-esophageal (GE) anatomy by placing transmural fastener sets in critical GE locations. How each successive fastener set impacts LES valve anatomy and physiology is unknown. METHODS & PROCEDURES: While… Continue Reading
- Type:
- Posters
- Topic:
- Endolumenal / NOTES
Intestinal Occlusion Catheter for Natural Orifice Translumenal Endoscopic Surgery (notes)
Background: Significant bowel distention can result from lumenal gas insufflation during NOTES procedures. This can reduce the peritoneal cavity operative domain. Bowel distention may be more apparent with tunneling-type access techniques that require more time to cross the viscus wall. Objective: Utilizing commercially available products, we designed an intestinal occlusion catheter (IOC) that can be… Continue Reading
- Type:
- Posters
- Topic:
- Endolumenal / NOTES
Is NOTES mesh placement safe? Results of a randomized blinded trial comparing NOTES and laparoscopy
Background: Ventral hernia repair with mesh is a frequently performed procedure and the Natural Orifice Translumenal Endoscopic Surgery (NOTES) concept might be adaptable for hernia repairs avoiding incision in the abdominal wall. The risk for infection in mesh placement is of concern. We compared abdominal wall mesh placement via NOTES with the laparoscopic mesh placement.Hypothesis:… Continue Reading
- Type:
- Posters
- Topic:
- Endolumenal / NOTES
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… Continue Reading
- Type:
- Podium Presentations
- Topic:
- Endolumenal / NOTES
Lessons Learned About Informed Consent in 9 Attempted NOTES Cases
Objective: the advent of the NOTES approach_ either transvaginal or transgastric_ has raised issues regarding the informed consent process_ required from an ethical and legal point of view_ as well as doubts from the patients regarding the indication and justification of the operation. Methods and procedures: starting August 2007, we attempted to perform 9 NOTES… Continue Reading
- Type:
- Posters
- Topic:
- Endolumenal / NOTES
Magnetic Retraction for NOTES Transvaginal Cholecystectomy
Introduction: Natural orifice surgery (NOTES) has the potential to decrease the burden of an operation on a patient. Limitations of the endoscopic platform require innovative solutions to provide retraction and create an operation comparable to the gold standard, laparoscopic cholecystectomy. Methods: Four patients underwent transvaginal cholecystectomy. All procedures were performed under laparoscopic vision to ensure… Continue Reading
- Type:
- Podium Presentations
- Topic:
- Endolumenal / NOTES
Maximizing Coupling Strength of Magnetically Anchored NOTES Instruments: How Thick Can We Go?
Introduction: The Magnetic Anchoring and Guidance System (MAGS) includes a handheld external magnet that controls deployable internal surgical instruments (camera, auxiliary light source, grasper, retractors, and cautery dissector) via magnetic attraction forces. We have successfully performed transvaginal NOTES cholecystectomy using MAGS instruments in porcine models with up to 2.5cm thick abdominal walls. The purpose of… Continue Reading
- Type:
- Posters
- Topic:
- Endolumenal / NOTES
Microbial Contamination of the Peritoneum Is Common Following Transgastric Endoscopic Surgery
INTRODUCTION: In Natural Orifice Transluminal Endoscopic Surgery (NOTES), intentional perforation of viscus to access the peritoneal cavity violates basic principles of surgery and raises questions regarding its safety. The aim of this study was to investigate if the transgastric approach could affect the peritoneal cavity by transluminal contamination. MATERIALS AND METHODS: A total of 7… Continue Reading
- Type:
- Posters
- Topic:
- Endolumenal / NOTES
Natural Orifice Cholecystectomy Using a Miniature Robot
Introduction: Natural Orifice Translumenal Endoscopic Surgery (NOTES) is surgically challenging. Current endoscopic tools provide an insufficient platform for visualization and manipulation. This study demonstrates the feasibility of using a miniature in vivo robot to enhance visualization and provide off-axis dexterous manipulation capabilities for NOTES. Methods: We developed a dexterous, miniature robot with six degrees-of-freedom capable… Continue Reading
- Type:
- Podium Presentations
- Topic:
- Endolumenal / NOTES
Natural Orifice Transesophageal Mediastinoscopy and Thoracoscopy: A Survival Series in Swine
Introduction: Mediastinoscopy (MX) and thoracoscopy (TX) are common procedures with painful incisions and prominent scars. A natural orifice transesophageal endoscopic surgery (NOTES) approach could reduce pain, eliminate intercostal neuralgia, provide access to the posterior mediastinal compartment or hilum, and improve cosmesis. The purpose of this study is to create a survival animal model for NOTES… Continue Reading
- Type:
- Podium Presentations
- Topic:
- Endolumenal / NOTES
Natural Orifice Translumenal Endoscopic Drainage for Pancreatic Abscesses
INTRODUCTION: Endoscopic pseudocyst drainage is well documented, but few series describe endoscopic drainage of pancreatic abscesses. Abscesses are complications of pancreatitis, presenting with sepsis and/or peritonitis. We report the feasibility and efficacy of natural orifice translumenal endoscopic surgery for pancreatic abscesses. METHODS: We reviewed consecutively treated patients (1994-2007). Approaches alone or in combination were: (1)… Continue Reading
- Type:
- Podium Presentations
- Topic:
- Endolumenal / NOTES
Natural Orifice Translumenal Endoscopic Surgery (NOTES) Peritoneoscopy Versus Laparoscopy to evaluate Intra-Abdominal Pathology in a Porcine Model
Background: The decision to operate on the intensive care patient with a questionable abdominal source of sepsis continues to prove difficult despite advancements in radiographic imaging. We believe a bedside trans-gastric NOTES exploration could be a valuable diagnostic tool in this setting.Methods: An acute, non-survival, study of 8 pigs was performed. Pigs were randomized to… Continue Reading
- Type:
- Posters
- Topic:
- Endolumenal / NOTES
Natural Orifice Translumenal Endoscopic Surgery with a Miniature in Vivo Surgical Robot
Introduction: The application of flexible endoscopy tools for Natural Orifice Translumenal Endoscopic Surgery (NOTES) is constrained due to limitations in dexterity, instrument insertion, navigation, visualization, and retraction. Miniature endolumenal robots that are not constrained by the natural orifice can mitigate these constraints through providing a stable platform for visualization and dexterous manipulation. This video demonstrates… Continue Reading
- Type:
- Podium Presentations
- Topic:
- Endolumenal / NOTES
New Technique for Gastrotomy Closure in NOTES and its Comparison with Endoclips
INTRODUCTION: Numerous experimental studies have been conducted to evaluate, explore, and develop Natural Orifice Transluminal Endoscopic Surgery (NOTES). The results have been varied ranging from mediocre to excellent. The most common challenge and perhaps the main limiting factor for the progress of NOTES has been the issue of adequate and effective gastrotomy closure. We describe… Continue Reading
- Type:
- Posters
- Topic:
- Endolumenal / NOTES