| Figures/Tab
lesFigures/Tab
les | ReferencesReferencesl version=""1.0"" encoding=""UTF-8""?>
lass=""h4"">Objective
To compare the feasibi
lity of porcine transrecta
l (TR) and transvagina
l (TV) hybrid natura
l orifice trans
lumina
l endoscopic surgery (NOTES) partia
l nephrectomy (PN), as NOTES nephrectomy has recent
ly been performed in the porcine mode
l.
lass=""h4"">Materials and Methods
A total of 10 female pigs (weight 45 kg) underwent TR (n?= 5) or TV (n?= 5) NOTES PN. The pneumoperitoneum was created by a periumbilical 12-mm trocar, through which a laparoscope was advanced for intra-abdominal visualization. For TV-NOTES PN, a gastroscope was used to obtain TV peritoneal access. For TR-NOTES PN, a horizontal incision was made 2 cm above the dentate line, and a submucosal tunnel was created in the posterior rectal wall. The gastroscope was advanced through the submucosal tunnel and retroperitoneum to the kidney, and a peritoneal window was created. For both TR- and TV-NOTES PN, the gastroscope was exchanged for the SPIDER Surgical System. Flexible dissecting instruments and hook cautery introduced through the SPIDER Surgical System were used to mobilize the kidney. A harmonic scalpel introduced periumbilically was used to excise a portion of the lower pole. LAPRA-TY-secured sutured renorrhaphy was performed, followed by TR or TV specimen extraction.
lass=""h4"">Results
TR- and TV-NOTES PN was successfully performed in all 10 pigs. A comparison of TR- and TV-NOTES PN revealed no significant differences in the mean access time (29.2 vs 29.6 minutes, P?= .944), operative time (196.0 vs 183.0 minutes, P?= .631), and estimated blood loss (59.0 vs 54.0 mL, P?= .861). Necropsy did not demonstrate abdominal injuries.
lass=""h4"">Conclusion
We have demonstrated proof-of-principle for TR and TV-NOTES PN in swine, with comparable perioperative parameters. Preclinical survival studies are requisite to assess the potential of TR-NOTES as an alternative to TV-NOTES.
