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Survival study of natural orifice translumenal endoscopic surgery for rectosigmoid resection using transanal endoscopic microsurgery with or without transgastric endoscopic assistance in a swine model

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Abstract

Background

The feasibility of transanal rectosigmoid resection with transanal endoscopic microsurgery (TEM) was previously demonstrated in a swine nonsurvival model in which transgastric endoscopic assistance also was shown to extend the length of colon mobilized transanally.

Methods

A 2-week survival study evaluating transanal endoscopic rectosigmoid resection with stapled colorectal anastomosis was conducted with swine using the transanal approach alone (TEM group, n = 10) or a transanal approach combined with transgastric endoscopic assistance (TEM + TG group, n = 10). Gastrotomies were created using a needleknife and balloon dilation, then closed using prototype T-tags. Outcomes were evaluated and compared between the groups using Student’s t-test and Fisher’s exact test.

Results

Relative to the TEM group, the average length of rectosigmoid mobilized in the TEM + TG group was 15.6 versus 10.5 cm (p < 0.0005), the length of the resected specimen was 9 versus 6.2 cm (p < 0.0005), and the mean operative time was 254.5 versus 97.5 min (p < 0.0005). Intraoperatively, no organ injury or major bleeding was noted. Two T-tag misfires occurred during gastrotomy closure and four small staple line defects requiring transanal repair including one in the TEM group and three in the TEM + TG group (p = 0.2). Postoperatively, there was no mortality, and the animals gained an average of 3.4 lb. Two major complications (10%) were identified at necropsy in the TEM + TG group including an intraabdominal abscess and an abdominal wall hematoma related to T-tag misfire. Gastrotomy closure sites and colorectal anastomoses were all grossly healed, with adhesions noted in 60 and 70% and microabscesses in 50 and 20% of the gastrotomy sites and colorectal anastomoses, respectively.

Conclusions

Natural orifice translumenal endoscopic surgery (NOTES) for rectosigmoid resection using TEM with or without transgastric endoscopic assistance is feasible and associated with low morbidity in a porcine survival model. Transgastric assistance significantly prolongs the operative time but extends the length of the rectosigmoid mobilized transanally, with a nonsignificant increase in complication rates related to gastrotomy creation.

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Acknowledgments

We acknowledge Christopher Hoffman, BA, for his help and expertise with perioperative animal care, and Drs. Desilets, Romanelli, Romero, and Earle and Vihar Surti (biomedical engineering) who developed the T-tag gastrotomy closure prototype. This work was supported by a research grant from NOSCAR (Natural Orifice Consortium for Assessment and Research).

Disclosures

Patricia Sylla is a consultant for Covidien; William R. Brugge is a consultant for Boston Scientific; and David W. Rattner is a consultant for Olympus. Dae Kyung Sohn, Sevdenur Cizginer, Yusuf Konuk, Brian G. Turner, Denise W. Gee, Field F. Willingham, Maylee Hsu, and Mari Mino-Kenudson have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Department of Surgery, Massachusetts General Hospital, Harvard Medical School, 15 Parkman Street, WACC 460, Boston, MA, 02114, USA

    Patricia Sylla, Yusuf Konuk, Denise W. Gee & David W. Rattner

  2. Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA

    Sevdenur Cizginer, Brian G. Turner, Field F. Willingham & William R. Brugge

  3. Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA

    Maylee Hsu & Mari Mino-Kenudson

  4. Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea

    Dae Kyung Sohn

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  1. Patricia Sylla
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Correspondence to Patricia Sylla.

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Sylla, P., Sohn, D.K., Cizginer, S. et al. Survival study of natural orifice translumenal endoscopic surgery for rectosigmoid resection using transanal endoscopic microsurgery with or without transgastric endoscopic assistance in a swine model. Surg Endosc 24, 2022–2030 (2010). https://doi.org/10.1007/s00464-010-0898-0

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  • DOI: https://doi.org/10.1007/s00464-010-0898-0

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