Detailed Abstract
[Liver Symposium 5 - Innovative Technologies in HBP Surgery]
[LV SY 5-3] Application of NOTES in the field of HBP Surgery
Il Young Park
Catholic University, Korea
Natural orifice translumenal endoscopic surgery (NOTES) is a promising field. It is new approach for both surgeons and gastroenteologists. Natural orifice includes mouth, vulva, anus and urethra. NOTES can be performed through a transluminal opening of the stomach, vagina, colon or bladder.
NOTES procedure has developed successfully in animal model. Still, there are technical difficulties and ethical problems in humans. NOTES have multiple advantages. For start, there is no hole in the abdominal wall after the surgery, leading to less visible scar. Then there are few complications such as pain, ileus adhesion and hernia, which prompt earlier discharge of patients. NOTES, however, has its limitations such as bacterial contamination and inability to deal with major complications - bleeding, laceration and perforation.
Recently, transesophageal and transoralmediastinal approaches are developed. In achalasia patients, perioral endoscopic myotomy (POEM) is a successful NOTES technique and has the possibility of replacing Heller myotomy. Transoralmediastinal lymphadenectomy and transoral endoscopic thyroidectomy vestibular approach were performed successfully. Transcolonic NOTES has evolved as the minimal invasive colorectal operation.
Application of NOTES in the field of HBP surgery has developed rapidly in cholecystectomy. Transvaginal cholecystectomy in human was started by several groups in 2007. It became relatively popular. Nevertheless, it can be done only in women and might cuase infertility and dyspareunia. First transgastric cholecystectomy in human was reported in 2009. Transgastric approach has problems in gastric wall closure. It was performed with endoscopic clips and/or suturing techniques, which might result in insufficient closing without laparoscopic aid. Transcolonic cholecystectomy in was reported only in a porcine model. This approach has contamination problems. Recently, a device for reversible endoluminal colon occlusion was validated in a porcine cholecystectomy. NOTES in the HPB fields, were done with various surgical techniques on animal models such as transvaginal liver resection or splenectomy, trancolonic distal pancreatectomy.
NOTES procedure has developed successfully in animal model. Still, there are technical difficulties and ethical problems in humans. NOTES have multiple advantages. For start, there is no hole in the abdominal wall after the surgery, leading to less visible scar. Then there are few complications such as pain, ileus adhesion and hernia, which prompt earlier discharge of patients. NOTES, however, has its limitations such as bacterial contamination and inability to deal with major complications - bleeding, laceration and perforation.
Recently, transesophageal and transoralmediastinal approaches are developed. In achalasia patients, perioral endoscopic myotomy (POEM) is a successful NOTES technique and has the possibility of replacing Heller myotomy. Transoralmediastinal lymphadenectomy and transoral endoscopic thyroidectomy vestibular approach were performed successfully. Transcolonic NOTES has evolved as the minimal invasive colorectal operation.
Application of NOTES in the field of HBP surgery has developed rapidly in cholecystectomy. Transvaginal cholecystectomy in human was started by several groups in 2007. It became relatively popular. Nevertheless, it can be done only in women and might cuase infertility and dyspareunia. First transgastric cholecystectomy in human was reported in 2009. Transgastric approach has problems in gastric wall closure. It was performed with endoscopic clips and/or suturing techniques, which might result in insufficient closing without laparoscopic aid. Transcolonic cholecystectomy in was reported only in a porcine model. This approach has contamination problems. Recently, a device for reversible endoluminal colon occlusion was validated in a porcine cholecystectomy. NOTES in the HPB fields, were done with various surgical techniques on animal models such as transvaginal liver resection or splenectomy, trancolonic distal pancreatectomy.
SESSION
Liver Symposium 5
Room B 3/31/2018 5:10 PM - 5:30 PM