Single-port endoscopic cholecystectomy: a bridge between laparoscopic and translumenal endoscopic surgery.

BACKGROUND AND OBJECTIVE The intentional puncture of the normal viscera is likely the most important issue limiting the widespread use of natural orifice translumenal endoscopic surgery (NOTES). We developed a new procedure for cholecystectomy using a flexible endoscope via a single port placed in the abdominal wall without visceral puncture (single-port endoscopic cholecystectomy; SPEC) as a bridge between laparoscopic surgery and NOTES. This study aimed to evaluate the technical feasibility of SPEC. METHODS Five pigs were subjected to SPEC. An endoscope was inserted through a 12-mm port placed in the right upper abdomen. After grasping and retracting the gallbladder using a 2-mm retractor that was directly introduced into the peritoneal cavity, gallbladder excision with ligation of the cystic artery and duct using endoclips was carried out. RESULTS A complete gallbladder excision was carried out easily and safely in all cases. No major adverse events occurred. The mean operating time was 67 min (range 52-84 min). CONCLUSIONS SPEC is a technically feasible procedure. It is simpler, easier, and safer than NOTES cholecystectomy. SPEC could be a less invasive alternative to the conventional four-port laparoscopic cholecystectomy.

[1]  D. Gouma,et al.  Flowcharts for the diagnosis and treatment of acute cholangitis and cholecystitis: Tokyo Guidelines , 2007, Journal of hepato-biliary-pancreatic surgery.

[2]  P. Pasricha,et al.  A novel safe approach to the peritoneal cavity for per-oral transgastric endoscopic procedures. , 2007, Gastrointestinal endoscopy.

[3]  Yair Lotan,et al.  Transvaginal laparoscopic nephrectomy: development and feasibility in the porcine model. , 2002, Urology.

[4]  Tiago Henriques-Coelho,et al.  Transvesical endoscopic peritoneoscopy: a novel 5 mm port for intra-abdominal scarless surgery. , 2006, The Journal of urology.

[5]  R. Parthasarathi,et al.  Transumbilical endoscopic appendectomy in humans: on the road to NOTES: a prospective study. , 2008, Journal of laparoendoscopic & advanced surgical techniques. Part A.

[6]  Tiago Henriques-Coelho,et al.  Third-generation cholecystectomy by natural orifices: transgastric and transvesical combined approach (with video). , 2007, Gastrointestinal endoscopy.

[7]  Jeffrey L. Ponsky,et al.  PEG “Rescue”: a practical NOTES technique , 2007, Surgical Endoscopy.

[8]  A. Saber,et al.  Single Incision Laparoscopic Sleeve Gastrectomy (SILS): A Novel Technique , 2008, Obesity surgery.

[9]  D. Gouma,et al.  Surgical treatment of patients with acute cholecystitis: Tokyo Guidelines , 2007, Journal of hepato-biliary-pancreatic surgery.

[10]  K W Lee,et al.  Two-port needlescopic cholecystectomy: prospective study of 100 cases. , 2005, Hong Kong medical journal = Xianggang yi xue za zhi.

[11]  R. Zorron,et al.  NOTES Transvaginal Cholecystectomy: Report of the First Case , 2007, Surgical innovation.

[12]  Richard Bergs,et al.  Completely transvaginal NOTES cholecystectomy using magnetically anchored instruments , 2007, Surgical Endoscopy.

[13]  J. Noguera,et al.  [Transvaginal cholecystectomy (NOTES) combined with minilaparoscopy]. , 2007, Revista espanola de enfermedades digestivas : organo oficial de la Sociedad Espanola de Patologia Digestiva.

[14]  Paul Swain,et al.  Experimental studies of transgastric gallbladder surgery: cholecystectomy and cholecystogastric anastomosis (videos). , 2005, Gastrointestinal Endoscopy.

[15]  Miguel A. Cuesta,et al.  The “invisible cholecystectomy”: A transumbilical laparoscopic operation without a scar , 2008, Surgical Endoscopy.

[16]  M. Talamini,et al.  Transgastric endoscopic splenectomy , 2006, Surgical Endoscopy And Other Interventional Techniques.

[17]  Y. Atomi,et al.  Cholecystectomy by a combined transgastric and transparietal approach using two flexible endoscopes. , 2009, Journal of hepato-biliary-pancreatic surgery.

[18]  C. Zornig,et al.  Laparoscopic cholecystectomy without visible scar: combined transvaginal and transumbilical approach , 2007, Endoscopy.

[19]  J. Rosenberg,et al.  Microlaparoscopic vs conventional laparoscopic cholecystectomy , 2002, Surgical Endoscopy And Other Interventional Techniques.

[20]  R. Tacchino,et al.  Single-incision laparoscopic cholecystectomy: surgery without a visible scar , 2009, Surgical Endoscopy.

[21]  K. C. Chan,et al.  Two-port versus four-port laparoscopic cholecystectomy , 2003, Surgical Endoscopy And Other Interventional Techniques.

[22]  E. J. Hanly,et al.  Hybrid minimally invasive surgery—a bridge between laparoscopic and translumenal surgery , 2007, Surgical Endoscopy.

[23]  Y. Atomi,et al.  Laparoscopic lymph node dissection after endoscopic submucosal dissection: a novel and minimally invasive approach to treating early-stage gastric cancer. , 2005, American journal of surgery.

[24]  M. Kumar,et al.  Three-Port Versus Standard Four-Port Laparoscopic Cholecystectomy: a Randomized Controlled Clinical Trial in a Community-Based Teaching Hospital in Eastern Nepal , 2007, JSLS : Journal of the Society of Laparoendoscopic Surgeons.

[25]  Christopher C Thompson,et al.  Peroral transgastric organ resection: a feasibility study in pigs. , 2006, Gastrointestinal endoscopy.

[26]  P. Senthilnathan,et al.  Transumbilical flexible endoscopic cholecystectomy in humans: first feasibility study using a hybrid technique , 2008, Endoscopy.

[27]  Christopher C Thompson,et al.  Transcolonic endoscopic cholecystectomy: a NOTES survival study in a porcine model (with video). , 2006, Gastrointestinal endoscopy.

[28]  Y. Atomi,et al.  Successful treatment of early stage gastric cancer by laparoscopy-assisted endoscopic full-thickness resection with lymphadenectomy. , 2008, Gastrointestinal endoscopy.

[29]  François Pugin,et al.  Single port access laparoscopic right hemicolectomy , 2008, International Journal of Colorectal Disease.

[30]  Kazuki Sumiyama,et al.  Pilot study of the porcine uterine horn as an in vivo appendicitis model for development of endoscopic transgastric appendectomy. , 2006, Gastrointestinal endoscopy.

[31]  Y. Atomi,et al.  Key factors for successful en bloc endoscopic submucosal dissection of early stage gastric cancer using an insulation-tipped diathermic knife. , 2006, Hepato-gastroenterology.

[32]  Chinnusamy Palanivelu,et al.  Transvaginal endoscopic appendectomy in humans: a unique approach to NOTES—world’s first report , 2008, Surgical Endoscopy.

[33]  Vikesh K. Singh,et al.  Flexible transgastric peritoneoscopy: a novel approach to diagnostic and therapeutic interventions in the peritoneal cavity. , 2004, Gastrointestinal endoscopy.

[34]  L. Sarli,et al.  Randomized clinical trial of laparoscopic cholecystectomy performed with mini‐instruments , 2003, The British journal of surgery.

[35]  C. Zornig,et al.  Scarless cholecystectomy with combined transvaginal and transumbilical approach in a series of 20 patients , 2008, Surgical Endoscopy.

[36]  Ninh T. Nguyen,et al.  Laparoscopic Transumbilical Cholecystectomy Without Visible Abdominal Scars , 2009, Journal of Gastrointestinal Surgery.

[37]  S. Varadarajulu,et al.  Patient perception of natural orifice transluminal endoscopic surgery as a technique for cholecystectomy. , 2008, Gastrointestinal endoscopy.

[38]  M. Talamini,et al.  NOTES: the hybrid technique. , 2007, Journal of laparoendoscopic & advanced surgical techniques. Part A.

[39]  M. J. Pollack,et al.  Quality in endoscopy: it starts during fellowship. , 2008, Gastrointestinal endoscopy.

[40]  J. Ponsky,et al.  Natural Orifice Translumenal Endoscopic Surgery: A Critical Review , 2008, Journal of Gastrointestinal Surgery.

[41]  Wen Li,et al.  Investigation for Acceptance of Natural Orifice Translumenal Endoscopic Surgery By Inpatients with Digestive Diseases , 2008 .

[42]  İ. Barut,et al.  Three-port versus four-port laparoscopic cholecystectomy. , 2007, Hepato-gastroenterology.

[43]  J. Sweeney,et al.  Transumbilical Gelport Access Technique for Performing Single Incision Laparoscopic Surgery (SILS) , 2008, Journal of Gastrointestinal Surgery.

[44]  G. Carvalho,et al.  NOTES transvaginal cholecystectomy: preliminary clinical application , 2008, Surgical Endoscopy.

[45]  Sergey V Kantsevoy,et al.  Peroral transgastric endoscopic ligation of fallopian tubes with long-term survival in a porcine model. , 2005, Gastrointestinal endoscopy.

[46]  Didier Mutter,et al.  Surgery without scars: report of transluminal cholecystectomy in a human being. , 2007, Archives of surgery.