Comparison of transrectal and transvaginal hybrid natural orifice transluminal endoscopic surgery partial nephrectomy in the porcine model

Wassim M. Bazzi; Sean P. Stroup; Seth A. Cohen; David M. Sisul; Michael A. Liss; James H. Masterson; Ryan P. Kopp; Suzanne R. Gudeman; Elisabeth Leeflang; Kerrin L. Palazzi; Sonia Ramamoorthy; Christopher J. Kane; Santiago Horgan; Ithaar H. Derweesh

doi:10.1016/j.urology.2013.03.007

Comparison of transrectal and transvaginal hybrid natural orifice transluminal endoscopic surgery partial nephrectomy in the porcine model

Wassim M. Bazzi, Sean P. Stroup, Seth A. Cohen, David M. Sisul, Michael A. Liss, James H. Masterson, Ryan P. Kopp, Suzanne R. Gudeman, Elisabeth Leeflang, Kerrin L. Palazzi, Sonia Ramamoorthy, Christopher J. Kane, Santiago Horgan, Ithaar H. Derweesh

Research output: Contribution to journal › Article › peer-review

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Abstract

Objective: To compare the feasibility of porcine transrectal (TR) and transvaginal (TV) hybrid natural orifice transluminal endoscopic surgery (NOTES) partial nephrectomy (PN), as NOTES nephrectomy has recently been performed in the porcine model. 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. 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. 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.

Original language	English (US)
Pages (from-to)	84-89
Number of pages	6
Journal	Urology
Volume	82
Issue number	1
DOIs	https://doi.org/10.1016/j.urology.2013.03.007
State	Published - Jul 2013
Externally published	Yes

ASJC Scopus subject areas

Urology

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Bazzi, W. M., Stroup, S. P., Cohen, S. A., Sisul, D. M., Liss, M. A., Masterson, J. H., Kopp, R. P., Gudeman, S. R., Leeflang, E., Palazzi, K. L., Ramamoorthy, S., Kane, C. J., Horgan, S., & Derweesh, I. H. (2013). Comparison of transrectal and transvaginal hybrid natural orifice transluminal endoscopic surgery partial nephrectomy in the porcine model. Urology, 82(1), 84-89. https://doi.org/10.1016/j.urology.2013.03.007

Bazzi, WM, Stroup, SP, Cohen, SA, Sisul, DM, Liss, MA, Masterson, JH, Kopp, RP, Gudeman, SR, Leeflang, E, Palazzi, KL, Ramamoorthy, S, Kane, CJ, Horgan, S & Derweesh, IH 2013, 'Comparison of transrectal and transvaginal hybrid natural orifice transluminal endoscopic surgery partial nephrectomy in the porcine model', Urology, vol. 82, no. 1, pp. 84-89. https://doi.org/10.1016/j.urology.2013.03.007

@article{5cb0c7bdaffc4f4683927b7f020a7491,

title = "Comparison of transrectal and transvaginal hybrid natural orifice transluminal endoscopic surgery partial nephrectomy in the porcine model",

abstract = "Objective: To compare the feasibility of porcine transrectal (TR) and transvaginal (TV) hybrid natural orifice transluminal endoscopic surgery (NOTES) partial nephrectomy (PN), as NOTES nephrectomy has recently been performed in the porcine model. 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. 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. 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.",

author = "Bazzi, {Wassim M.} and Stroup, {Sean P.} and Cohen, {Seth A.} and Sisul, {David M.} and Liss, {Michael A.} and Masterson, {James H.} and Kopp, {Ryan P.} and Gudeman, {Suzanne R.} and Elisabeth Leeflang and Palazzi, {Kerrin L.} and Sonia Ramamoorthy and Kane, {Christopher J.} and Santiago Horgan and Derweesh, {Ithaar H.}",

note = "Funding Information: Funding Support: This study was supported by the Stephen Weissman Kidney Cancer Research Fund . ",

year = "2013",

month = jul,

doi = "10.1016/j.urology.2013.03.007",

language = "English (US)",

volume = "82",

pages = "84--89",

journal = "Urology",

issn = "0090-4295",

publisher = "Elsevier Inc.",

number = "1",

}

TY - JOUR

T1 - Comparison of transrectal and transvaginal hybrid natural orifice transluminal endoscopic surgery partial nephrectomy in the porcine model

AU - Bazzi, Wassim M.

AU - Stroup, Sean P.

AU - Cohen, Seth A.

AU - Sisul, David M.

AU - Liss, Michael A.

AU - Masterson, James H.

AU - Kopp, Ryan P.

AU - Gudeman, Suzanne R.

AU - Leeflang, Elisabeth

AU - Palazzi, Kerrin L.

AU - Ramamoorthy, Sonia

AU - Kane, Christopher J.

AU - Horgan, Santiago

AU - Derweesh, Ithaar H.

N1 - Funding Information: Funding Support: This study was supported by the Stephen Weissman Kidney Cancer Research Fund .

PY - 2013/7

Y1 - 2013/7

N2 - Objective: To compare the feasibility of porcine transrectal (TR) and transvaginal (TV) hybrid natural orifice transluminal endoscopic surgery (NOTES) partial nephrectomy (PN), as NOTES nephrectomy has recently been performed in the porcine model. 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. 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. 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.

AB - Objective: To compare the feasibility of porcine transrectal (TR) and transvaginal (TV) hybrid natural orifice transluminal endoscopic surgery (NOTES) partial nephrectomy (PN), as NOTES nephrectomy has recently been performed in the porcine model. 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. 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. 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.

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Comparison of transrectal and transvaginal hybrid natural orifice transluminal endoscopic surgery partial nephrectomy in the porcine model

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