Published online Oct 28, 2013. doi: 10.3748/wjg.v19.i40.6857
Revised: August 29, 2013
Accepted: September 3, 2013
Published online: October 28, 2013
Processing time: 195 Days and 20.8 Hours
AIM: To investigate the feasibility and safety of Natural orifice trans-umbilical endoscopic cholecystectomy with a water-jet hybrid-knife in a non-survival porcine model.
METHODS: Pure natural orifice transluminal endoscopic surgery (NOTES) cholecystectomy was performed on three non-survival pigs, by transumbilical approach, using a water-jet hybrid-knife. Under general anesthesia, the following steps detailed the procedure: (1) incision of the umbilicus followed by the passage of a double-channel flexible endsocope through an overtube into the peritoneal cavity; (2) establishment of pneumoperitoneum; (3) abdominal exploration; (4) endoscopic cholecystectomy: dissection of the gallbladder performed using water jet equipment, ligation of the cystic artery and duct conducted using nylon loops; and (5) necropsy with macroscopic evaluation.
RESULTS: Transumbilical endoscopic cholecystectomy was successfully completed in the first and third pig, with minor bleedings. The dissection times were 137 and 42 min, respectively. The total operation times were 167 and 69 min, respectively. And the lengths of resected specimen were 6.5 and 6.1 cm, respectively. Instillation of the fluid into the gallbladder bed produced edematous, distended tissue making separation safe and easy. Reliable ligation using double nylon loops insured the safety of cutting between the loops. There were no intraoperative complications or hemodynamic instability. Uncontrolled introperative bleeding occurred in the second case, leading to the operation failure.
CONCLUSION: Pure NOTES trans-umbilical cholecystectomy with a water-jet hybrid-knife appears to be feasible and safe. Further investigation of this technique with long-term follow-up in animals is needed to confirm the preliminary observation.
Core tip: Flexibile single-incision surgery (FSIS), one of recent advances in endoscopic surgery, is a promising single-incision approach, which has exploited the advantages of single-incision laparoscopy and narrow sense of natural orifice transluminal endoscopic surgery (NOTES). Compared to NOTES, FSIS uses the navel to facilitate the extraction of the specimen and the umbilical closure is quick and easy. Compared to SILS, FSIS does not need any specialized device for the entry ports. Furthermore, water-jet hybrid knife technology enables a quick switch between blunt and sharp dissection. This study assessed the feasibility and safety of endoscopic cholecystectomy using transumbilical approach and water jet hybrid knife technology.