Natural orifice transluminal endoscopic surgery in urology. Feasability of a transrectal, flexible retroperitoneoscopy in a porcine model

作者：Bschleipfer T^*; Hackethal A; Tacke S; Collet P

来源：Urologe, 2014, 53(12): 1786-1792.

DOI：10.1007/s00120-014-3653-7

• HybridKnife (R)
• Access, transrectal
• High-frequency surgery
• Water jet technology
• Endoscopy

Natural orifice transluminal endoscopic surgery (NOTES) in urology is becoming more and more interesting due to technical innovations. One of those innovations is the HybridKnifeA (R), a multifunctional sonde that combines high-frequency electrosurgery and water jet surgery. The aim of this study was to establish a transrectal, flexible endoscopic retroperitoneoscopy in a porcine model by means of the HybridKnifeA (R) for further development of a transrectal retroperitoneal NOTES lymphadenectomy (NOTES-RLA). %26lt;br%26gt;Five female pigs (25-30 kg body mass) were anesthetized and placed in a supine position. The rectal mucosa was opened 3-5 cm cranially of the linea dentata. After submucosal tunneling, the retrorectal space was opened. We performed a flexible endoscopic retroperitoneoscopy by means of a double-channel gastroscope 13.806 PKS (Karl Storz-Endoskope, Tuttlingen, Germany) and the HybridKnifeA (R) I-type (ERBE Elektromedizin, Tubingen, Germany). %26lt;br%26gt;Transrectal access was safe and feasible without any difficulties. Using the HybridKnifeA (R) water jet technology, the retroperitoneal space could be distended which enabled safe access to the iliacal vessels, the bifurcation of the aorta/vena cava, and the pre- and paraaortal/-caval space up to the renal vessels. The water jet did not lacerate or injure blood vessels, nerves, or lymph vessels in any of the surgical procedures. %26lt;br%26gt;By means of the HybridKnifeA (R), transrectal access into the retrorectal space is safe and easily feasible. The water jet technology combined with electrosurgery prevented injuries of blood vessels, nerves, and lymph vessels and enabled transrectal flexible endoscopic retroperitoneoscopy as a precondition for further establishment of a transrectal NOTES-RLA.

• 出版日期2014-12