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Fu T, Ren J, Yao H, Huang B, Sun L, Li X, Tong W. Feasibility and safety of hybrid transvaginal natural orifice transluminal endoscopic surgery for colon cancer: Protocol for a multicenter, single-arm, phase II trial (vNOTESCA). Heliyon 2023; 9:e20187. [PMID: 37780770 PMCID: PMC10539939 DOI: 10.1016/j.heliyon.2023.e20187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 09/04/2023] [Accepted: 09/13/2023] [Indexed: 10/03/2023] Open
Abstract
Introduction It has been a decade since the first patient with colon cancer underwent colectomy by hybrid transvaginal natural orifice transluminal endoscopic surgery (hvNOTES). However, the efficacy and safety of this procedure is not well established. Methods This study is an open-label, multicenter, single-arm, phase 2 trial undertaken at six centers in China. Female patients aged over 18 years and below 80 years old with an Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1, with pathologically proven, resectable, cT1-3N0-2M0 disease who have previously untreated colon cancer are eligible for inclusion. The primary endpoint is a composite of major intraoperative and postoperative complications (greater than grade III, the Common Terminology Criteria for Adverse Events [CTCAE], version 5.0). Secondary endpoints include conversion to laparoscopic or open surgery, postoperative concentration of C-Reactive Protein and procalcitonine, complete pathological assessment of complete mesocolic excision specimens, postoperative pain, amount of narcotic pain medication administered, time to first flatus after surgery, number of harvested lymph nodes, R0 resection rate, length of hospital stay, sexual function assessment, quality of recovery, satisfaction with surgical scars, quality of life, postoperative recurrence patterns, relapse-free survival, and overall survival. Ethics and dissemination The study was approved by the Research Ethics Committee, Renmin Hospital of Wuhan University, China, number: WDRY2022-K053. All patients will receive written information of the trial and provide informed consent before enrollment. The results of this trial will be disseminated in academic conferences and peer-reviewed medical journals.Trial registration number NCT04048421.
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Affiliation(s)
- Tao Fu
- Department of General Surgery, Qingdao Hospital, University of Health and Rehabilitation Sciences, Qingdao Municipal Hospital, China
- Department of Gastrointestinal Surgery II, Renmin Hospital of Wuhan University, China
| | - Jun Ren
- Department of Gastrointestinal Surgery II, Renmin Hospital of Wuhan University, China
| | - Hongwei Yao
- Department of Colorectal Surgery, Beijing Friendship Hospital of Capital Medical University, China
| | - Bin Huang
- Department of Gastrointestinal Surgery, Daping Hospital of Army Medical University, China
| | - Lifeng Sun
- Department of Colorectal Surgery, The Second Affiliated Hospital of Zhejiang University, China
| | - Xiaorong Li
- Department of Colorectal Surgery, The Third Xiangya Hospital of Central South University, China
| | - Weidong Tong
- Department of Gastrointestinal Surgery, Daping Hospital of Army Medical University, China
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Feasibility of transgastric endoscopic gallbladder-preserving surgery for benign gallbladder diseases (with video). Surg Endosc 2022; 36:2705-2711. [PMID: 35075524 DOI: 10.1007/s00464-021-08890-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 11/16/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND With the increasing realization of the importance of gallbladder function, choledochoscopic gallbladder-preserving surgery has been advocated for benign gallbladder diseases. However, limited information is available regarding the use of endoscopic gallbladder-preserving surgery (EGPS) for patients with benign gallbladder diseases. The aim of this study was to evaluate the feasibility of EGPS for benign gallbladder diseases. METHODS Between June 2020 and January 2021, 22 patients with gallbladder stones and/or gallbladder polyps were treated with EGPS. The main outcome measures included the rate of complications, residual gallbladder stones, and gallbladder stone recurrence. RESULTS In this study, transgastric EGPS was successfully performed in 22 patients (13 female, 9 male) with benign gallbladder diseases, and included 8 cases of multiple gallstones, 4 cases of gallbladder polyps with gallstones, 6 cases of multiple gallbladder polyps, 2 cases of single gallstone, and 2 case of singe gallbladder polyp. The median time of transgastric EGPS was 118 min. During hospitalization, 4 patients suffered localized peritonitis (4/22, 18.2%), and these patients successfully recovered after conservative medical treatment. None of the patients experienced massive bleeding, delayed bleeding, diffuse peritonitis, or any other serious complications. During the median follow-up of 4 months, 1 patient suffered residual gallstone, while no gallstone recurrence or deaths related to transgastric EGPS occurred in any patients. CONCLUSIONS Transgastric EGPS appears to be a feasible treatment method in selected patients with benign gallbladder diseases. However, as it is a new technique, further studies are needed to explore the long-term effectiveness of transgastric EGPS.
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Holländer S, von Heesen M, von Heesen A, Spiliotis AE, Gäbelein G, Scherber PR, Glanemann M. Minimally Invasive Cholecystectomy: Transvaginal or Transabdominal Approach-Which Technique Is Preferred by Female Hospital Employees? J Laparoendosc Adv Surg Tech A 2021; 32:515-521. [PMID: 34283667 DOI: 10.1089/lap.2021.0389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Evidence is lacking concerning a clear benefit of single-port laparoscopic cholecystectomy (SILC) and transvaginal cholecystectomy (TVC) over the classical laparoscopic cholecystectomy (CLC). In this study, we investigated the preferences of the operation techniques among female employees in a tertiary university clinic. Materials and Methods: Study participants in the department of general surgery and gynecology were interviewed regarding their personal felt preferences for the mentioned procedures using a standardized illustrated questionnaire. Results: A total of 111 participants were included in the study. In 70.3% of cases, the transvaginal approach was unknown. The classical techniques were preferred in 95.2% of respondents. Participants with a wish for children showed a higher preference for nontransvaginal techniques (P = .011). The acceptance rate of transvaginal techniques among employees of the department of gynecology was higher than those of the department of general surgery (P = .028). Conclusions: The overall acceptance rate for TVC is low. Especially in case of a wish for children, SILC and CLC represent the preferred techniques. The lack of popularity of TVC could be an explanation for the refusal of this technique. Among employees of the gynecologic department, a transvaginal approach was significantly more often accepted. The cosmetic outcome and the knowledge about an operation technique certainly influence the decision making for the preferred surgical method.
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Affiliation(s)
- Sebastian Holländer
- Department of General Surgery, Vascular-, Visceral- and Pediatric Surgery, Saarland University Medical Center, Homburg, Germany
| | - Maximilian von Heesen
- Department of General- and Visceral Surgery, University Hospital Göttingen, Göttingen, Germany
| | - Anika von Heesen
- Department of Gynecology, University Hospital Göttingen, Göttingen, Germany
| | - Antonios E Spiliotis
- Department of General Surgery, Vascular-, Visceral- and Pediatric Surgery, Saarland University Medical Center, Homburg, Germany
| | - Gereon Gäbelein
- Department of General Surgery, Vascular-, Visceral- and Pediatric Surgery, Saarland University Medical Center, Homburg, Germany
| | - Philipp Robert Scherber
- Department of General Surgery, Vascular-, Visceral- and Pediatric Surgery, Saarland University Medical Center, Homburg, Germany
| | - Matthias Glanemann
- Department of General Surgery, Vascular-, Visceral- and Pediatric Surgery, Saarland University Medical Center, Homburg, Germany
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Which Cholecystectomy Technique Would Surgeons Prefer on Themselves? Surg Laparosc Endosc Percutan Tech 2020; 30:495-499. [DOI: 10.1097/sle.0000000000000833] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Comparison of Major Clinical Outcomes Between Transvaginal NOTES and Traditional Laparoscopic Surgery: A Systematic Review and Meta-analysis. J Surg Res 2019; 244:278-290. [PMID: 31302326 DOI: 10.1016/j.jss.2019.06.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 04/25/2019] [Accepted: 06/05/2019] [Indexed: 12/29/2022]
Abstract
BACKGROUND The advent of transvaginal natural orifice transluminal endoscopic surgery (transvaginal NOTES) aims to minimize surgical trauma and reduce recovery time. MATERIALS AND METHODS Clinical trials comparing transvaginal NOTES and traditional laparoscopy were identified by searching EMBASE, MEDLINE, and Web of Science (from 2004 to March 2018). Major outcomes evaluated were risk of postoperative complications and secondary outcomes were pain on postoperative day (POD) 1, POD2, and POD3, time needed for full recovery, risk of intraoperative complications, the duration of surgery, and hospital stay. The results of the meta-analysis are presented as standardized mean difference (SMD) and risk difference (RD) with 95% confidence intervals (CIs). RESULTS Thirteen trials with 1340 patients were identified. There were no statistical differences for risk of complications between transvaginal NOTES and traditional laparoscopy (intraoperative complications: RD -0.01, 95% CI -0.03 to 0.01; P = 0.37; postoperative complication: RD -0.02, 95% CI -0.05 to 0.01; P = 0.148). The pain score was lower in transvaginal NOTES on POD1 (SMD: -0.71, 95% CI: -1.30 to -0.11, P = 0.019), on POD2 (SMD -0.41, 95% CI -0.75 to -0.07; P = 0.018), and on POD3 (SMD -0.43, 95% CI -0.63 to -0.23; P < 0.001). Patients in transvaginal NOTES needed much shorter time to fully recover after surgery (SMD -1.36, 95% CI -1.84 to -0.87; P < 0.001). In addition, patients underwent transvaginal NOTES had less pain and shorter time of recovery. CONCLUSIONS It is recommended that patients have cholecystectomy, adnexectomy, and appendectomy using transvaginal NOTES as it is safe and minimally invasive.
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Endoscopic Retrograde Cholangiopancreatography and Endoscopic Ultrasound-Guided Gallbladder Drainage. Gastrointest Endosc Clin N Am 2019; 29:293-310. [PMID: 30846154 DOI: 10.1016/j.giec.2018.12.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
"Gallbladder disease is one of the most common gastrointestinal diseases encountered in clinical practice. Surgical removal and percutaneous drainage are both widely available and effective in the management of acute cholecystitis. Several endoscopic approaches exist as an alternative to these interventions. These include transpapillary approaches via endoscopic retrograde cholangiopancreatography (ERCP), transmural drainage and access approaches via endoscopic ultrasound (EUS), and endoscopic surgical approaches using natural orifice transluminal endoscopic surgery (NOTES) techniques. This article reviews the epidemiology and pathophysiology of gallbladder diseases and discusses the various percutaneous, surgical, and endoscopic approaches to managing gallbladder disease."
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Carvalho GL, Lima DL, Shadduck PP, de Góes GHB, Alves de Carvalho GB, Cordeiro RN, Calheiros EMQ, Cavalcanti Dos Santos D. Which Cholecystectomy do Medical Students Prefer? JSLS 2019; 23:JSLS.2018.00086. [PMID: 30675093 PMCID: PMC6333563 DOI: 10.4293/jsls.2018.00086] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Introduction: This study was undertaken to identify which minimally invasive technique medical students prefer for cholecystectomy and what factors determine their decision. Methods: Brazilian medical students watched a video reviewing the advantages and disadvantages of six different surgical approaches to cholecystectomy: open surgery, conventional laparoscopy, mini-laparoscopy (MINI), single-incision laparoscopic surgery, natural-orifice transluminal endoscopic surgery, and robotic surgery. Respondents then answered questions about hypothetical situations in which the participants would be submitted to elective cholecystectomy. Results: One hundred eleven medical students completed the survey, 60 females (54%) and 51 males (46%). Most students were 19–26 years old. When asked whether they would consider an open cholecystectomy if minimally invasive surgery (MIS) techniques were available, only 9% answered yes. Senior medical students were the least willing to consider open surgery (P = .036). When asked if they would prefer conventional laparoscopy, MINI, or robotic surgery for their cholecystectomy, 85% of the women and 63% of the men chose MINI (P = .025). When asked if they would consider a single-incision laparoscopic surgery or natural-orifice transluminal endoscopic surgery approach, 94 respondents (84%) answered no. When asked to rank which factors they consider the most important when choosing a surgical technique, they ranked safety of the procedure first (58%) and surgeon experience second (30%). Conclusion: When Brazilian medical students were asked to select a surgical approach for cholecystectomy, most chose MINI. The preference for MINI was strongest amongst female medical students. Both female and male medical students ranked safety as the most important factor.
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Affiliation(s)
| | | | - Phillip P Shadduck
- Department of Surgery, Duke Regional Hospital, Duke University, Durham, North Carolina, USA
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Shen T, Hennings D, Nelson CA, Oleynikov D. Performance of a Multifunctional Robot for Natural Orifice Transluminal Endoscopic Surgery. Surg Innov 2018; 25:364-373. [PMID: 29909731 DOI: 10.1177/1553350618781225] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Natural orifice transluminal endoscopic surgery (NOTES) has gained attention as a revolutionary technique with its potential advantages in eliminating skin incisions, shortening recovery time, and decreasing postoperative complications; however, its practical application is still constrained by the complexity of navigation through the surgical field and paucity of available instruments. Current progress on NOTES focuses on designing flexible articulated robots or fully inserted bimanual robots to address the limitations. However, the lack of multitasking tools, trade-offs between size and power, and lack of sufficient surgical force are too often neglected. The authors designed a bimanual robot with a multifunctional manipulator, which can realize on-site instrument-change according to surgeon needs. An articulated drive mechanism with 2 independent curvature sections was designed to deliver the robot to the surgical site. A corresponding reconfiguration operation sequence was formulated to ease insertion and thereby decrease the design trade-off between size and power. This article presents 3 benchtop and animal tests to evaluate the robotic surgery approach and demonstrate the effectiveness of the robot.
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Affiliation(s)
- Tao Shen
- 1 University of Nebraska-Lincoln, Lincoln, NE, USA
| | | | - Carl A Nelson
- 1 University of Nebraska-Lincoln, Lincoln, NE, USA.,2 University of Nebraska Medical Center, Omaha, NE, USA
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Does obesity influence the results in Transvaginal Hybrid-NOTES cholecystectomy? Surg Endosc 2018; 32:4632-4638. [PMID: 29770882 DOI: 10.1007/s00464-018-6216-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 05/09/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND Morbidly obese patients are usually excluded from studies that compare Transvaginal Hybrid-NOTES Cholecystectomy (TVC) with traditional laparoscopic cholecystectomy. Therefore, these study results cannot necessarily be transferred to this group of patients. In this study, we have analyzed and compared the outcomes of the procedure with obese and non-obese patients. METHODS Data from a prospectively maintained database were retrospectively analyzed. All the TVCs performed in our clinic since 2008 were divided into groups according to their body mass index (BMI). Within these groups, we evaluated the following outcome parameters: age, ASA classification, procedural time, number of percutaneous trocars, intra- and postoperative complications, and postoperative hospital stay. Additionally, the posthospital surgical and gynecological follow-up was evaluated for additional complications and patients with class III obesity were contacted to determine further parameters. RESULTS Six underweight, 76 normal weight, 72 overweight, 48 class I obesity, 15 class II obesity, and 20 class III obesity patients were analyzed. ASA classification (P < 0.001), procedural time (P < 0.001), and number of percutaneous trocars (P < 0.001) significantly increased with the BMI. By contrast, intra- and postoperative complications (P = 0.134 and P = 0.571), as well as postoperative hospital stay (P = 0.076) did not depend on the BMI. Neither did the classification according to Clavien/Dindo show a significant relation (P = 0.640). Lethality was zero. All posthospital gynecological follow-ups were inconspicuous. Telephone follow-up of class III obesity patients reached a rate of 85% after median 3.4 years. There were no additional complications or problems during sexual intercourse. The satisfaction with the cosmetic and the overall result was very high. CONCLUSIONS Although the results of existing studies including normal-weight or merely moderately obese patients can hardly be applied to morbidly obese patients, especially regarding procedural time and the number of percutaneous trocars, obesity should not be an exclusion criterion for TVC, regardless of its magnitude.
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Müller PC, Senft JD, Gath P, Steinemann DC, Nickel F, Billeter AT, Müller-Stich BP, Linke GR. Transrectal rigid-hybrid NOTES cholecystectomy can be performed without peritoneal contamination: a controlled porcine survival study. Surg Endosc 2018; 32:478-484. [PMID: 28799061 DOI: 10.1007/s00464-017-5804-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 07/29/2017] [Indexed: 01/02/2023]
Abstract
BACKGROUND AND STUDY AIMS The risk of infectious complications due to peritoneal contamination is a major concern and inhibits the widespread use of transrectal NOTES. A standardized rectal washout with a reversible colon occlusion device in situ has previously shown potential in reducing peritoneal contamination. The aim of this study was to compare the peritoneal contamination rate and inflammatory reaction for transrectal cholecystectomy after ideal rectal preparation (trCCE) and standard laparoscopic cholecystectomy (lapCCE) in a porcine survival experiment. METHODS Twenty pigs were randomized to trCCE (n = 10) or lapCCE (n = 10). Before trCCE, rectal washout was performed with saline solution. A colon occlusion device was then inserted and a second washout with povidone-iodine was performed. The perioperative course and the inflammatory reaction (leukocytes, C-reactive protein) were compared. At necropsy, 14 days after surgery the abdominal cavity was screened for infectious complications and peritoneal swabs were obtained for comparison of peritoneal contamination. RESULTS Peritoneal contamination was lower after trCCE than after lapCCE (0/10 vs. 6/10; p = 0.003). No infectious complications were found at necropsy in either group and postoperative complications did not differ (p = 1.0). Immediately after the procedure, leukocytes were higher after lapCCE (17.0 ± 2.7 vs. 14.6 ± 2.3; p = 0.047). Leukocytes and C-reactive protein showed no difference in the further postoperative course. Intraoperative complications and total operation time (trCCE 114 ± 32 vs. 111 ± 27 min; p = 0.921) did not differ, but wound closure took longer for trCCE (31.5 ± 19 vs. 13 ± 5 min; p = 0.002). CONCLUSIONS After standardized rectal washout with a colon occlusion device in situ, trCCE was associated without peritoneal contamination and without access-related infectious complications. Based on the findings of this study, a randomized controlled clinical study comparing clinical outcomes of trCCE with lapCCE should be conducted.
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Affiliation(s)
- Philip C Müller
- Department of General, Visceral and Transplant Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.
| | - Jonas D Senft
- Department of General, Visceral and Transplant Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Philip Gath
- Department of General, Visceral and Transplant Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Daniel C Steinemann
- Department of General, Visceral and Transplant Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Felix Nickel
- Department of General, Visceral and Transplant Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Adrian T Billeter
- Department of General, Visceral and Transplant Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Beat P Müller-Stich
- Department of General, Visceral and Transplant Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Georg R Linke
- Department of General, Visceral and Transplant Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
- Department of Surgery, Hospital STS Thun AG, Krankenhausstrasse 12, 3600, Thun, Switzerland
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Mueck KM, Cherla DV, Taylor A, Ko TC, Liang MK, Kao LS. Randomized Controlled Trials Evaluating Patient-Reported Outcomes after Cholecystectomy: A Systematic Review. J Am Coll Surg 2017; 226:183-193.e5. [PMID: 29154921 DOI: 10.1016/j.jamcollsurg.2017.10.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 10/20/2017] [Accepted: 10/25/2017] [Indexed: 02/07/2023]
Affiliation(s)
- Krislynn M Mueck
- Department of Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX; Center for Surgical Trials and Evidence-based Practice (C-STEP), Departments of Surgery and Pediatric Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX.
| | - Deepa V Cherla
- Department of Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX; Center for Surgical Trials and Evidence-based Practice (C-STEP), Departments of Surgery and Pediatric Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX
| | - Amy Taylor
- Department of Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX
| | - Tien C Ko
- Department of Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX
| | - Mike K Liang
- Department of Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX; Center for Surgical Trials and Evidence-based Practice (C-STEP), Departments of Surgery and Pediatric Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX
| | - Lillian S Kao
- Department of Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX; Center for Surgical Trials and Evidence-based Practice (C-STEP), Departments of Surgery and Pediatric Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX
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Steinemann DC, Müller PC, Probst P, Schwarz AC, Büchler MW, Müller-Stich BP, Linke GR. Meta-analysis of hybrid natural-orifice transluminal endoscopic surgery versus laparoscopic surgery. Br J Surg 2017; 104:977-989. [DOI: 10.1002/bjs.10564] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 03/20/2017] [Accepted: 03/21/2017] [Indexed: 02/06/2023]
Abstract
Abstract
Background
Hybrid natural-orifice transluminal endoscopic surgery (NOTES), combining access through a natural orifice with small-sized abdominal trocars, aims to reduce pain and enhance recovery. The objective of this systematic review and meta-analysis was to compare pain and morbidity in hybrid NOTES and standard laparoscopy.
Methods
A systematic literature search was performed to identify RCTs and non- RCTs comparing hybrid NOTES and standard laparoscopy. The main outcome was pain on postoperative day (POD) 1. Secondary outcomes were pain during the further postsurgical course, rescue analgesia, complications, and satisfaction with the cosmetic result. The results of meta-analysis in a random-effects model were presented as odds ratio (ORs) or standard mean differences (MDs) with 95 per cent confidence intervals.
Results
Six RCTs and 21 non-randomized trials including 2186 patients were identified. In hybrid NOTES the score on the numerical pain scale was lower on POD 1 (−0·75, 95 per cent c.i. −1·09 to −0·42; P = 0·001) and on POD 2–4 (−0·58, −0·91 to −0·26; P < 0·001) than that for standard laparoscopy. The need for rescue analgesia was reduced in hybrid NOTES (OR 0·36, 0·24 to 0·54; P < 0·001). The reduction in complications found for hybrid NOTES compared with standard laparoscopy (OR 0·52, 0·38 to 0·71; P < 0·001) was not significant when only RCTs were considered (OR 0·83, 0·43 to 1·60; P = 0·570). The score for cosmetic satisfaction was higher after NOTES (MD 1·14, 0·57 to 1·71; P < 0·001).
Conclusion
Hybrid NOTES reduces postoperative pain and is associated with greater cosmetic satisfaction in selected patients.
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Affiliation(s)
- D C Steinemann
- Department of General, Visceral and Transplant Surgery, University of Heidelberg, Heidelberg, Germany
| | - P C Müller
- Department of General, Visceral and Transplant Surgery, University of Heidelberg, Heidelberg, Germany
| | - P Probst
- Department of General, Visceral and Transplant Surgery, University of Heidelberg, Heidelberg, Germany
- Study Centre of the German Surgical Society, University of Heidelberg, Heidelberg, Germany
| | - A-C Schwarz
- Department of General, Visceral and Transplant Surgery, University of Heidelberg, Heidelberg, Germany
| | - M W Büchler
- Department of General, Visceral and Transplant Surgery, University of Heidelberg, Heidelberg, Germany
| | - B P Müller-Stich
- Department of General, Visceral and Transplant Surgery, University of Heidelberg, Heidelberg, Germany
| | - G R Linke
- Department of General, Visceral and Transplant Surgery, University of Heidelberg, Heidelberg, Germany
- Department of Surgery, Spital STS AG, Thun, Switzerland
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Safety Outcomes of NOTES Cholecystectomy Versus Laparoscopic Cholecystectomy: A Systematic Review and Meta-Analysis. Surg Laparosc Endosc Percutan Tech 2017; 26:347-353. [PMID: 27557339 PMCID: PMC5054957 DOI: 10.1097/sle.0000000000000284] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Natural orifice transluminal endoscopic surgery (NOTES) is an endoscopic technique whereby surgical interventions can be performed with a flexible endoscope passed through a natural orifice (mouth, vulva, urethra, anus) then through a transluminal opening of the stomach, vagina, bladder, or colon. Although in the early stage of research and development, NOTES has been clinically applied across the globe, above all the transvaginal cholecystectomy is among the most frequently performed procedures. In the existing 2 types of transvaginal routes, the hybrid NOTES cholecystectomy (NC) is more likely to be accepted. However, there has been controversy regarding the safety outcomes of hybrid NC in comparison with classical laparoscopic cholecystectomy (LC). The primary objective of this meta-analysis is to compare the characteristics between NC and classical LC. MATERIALS AND METHODS A meta-analysis of eligible studies comparing NC with classical LC was performed to evaluate the safety outcomes including wound complications, other postoperative complications and intraoperative conversion between the 2 groups. RESULTS Pooling 3 randomized controlled trials (n=157) and 7 nonrandomized trial (n=593) demonstrated that the rates of wound complications and other postoperative complications in NC group did not significantly differ from those of classical LC group [wound complications: ratio difference (RD)=-0.02, 95% confidence interval (CI) -0.04to 0.01, P=0.23; other postoperative complication: RD=-0.01; 95% CI, -0.03 to 0.02; P=0.6]. The intraoperative conversion rate in NC groups was higher than that of LC groups (RD=0.03; 95% CI, 0.01-0.06; P=0.02). CONCLUSIONS There is no significate difference between the safety of NC and laparoscope cholecystectomy. NC is associated with a higher rate of intraoperative conversion when compared with LC. It is worthy of further promotion and validation in clinical settings.
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Moloney JM, Gan PSL. Hybrid Transvaginal NOTES and Mini-Laparoscopic Colectomy: Benefit Through Synergy. JSLS 2017; 20:JSLS.2016.00062. [PMID: 27904307 PMCID: PMC5103299 DOI: 10.4293/jsls.2016.00062] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background and Objectives: Hybrid-natural orifice surgery combines the advantages of traditional transabdominal laparoscopic surgery, while limiting surgical trauma to the abdominal wall. Among various routes of intra-abdominal access, the transvaginal method is most appealing because of its utility and proven safety. We describe a series of 4 colonic resections performed with this approach, combined with minilaparoscopy and needlescopic approaches, and discuss the technical aspects, efficacy, and applicability of this technique. Methods: Three patients were selected to undergo hybrid transvaginal natural-orifice right hemicolectomy. A fourth patient, who underwent a segmental resection of a splenic flexure carcinoma, was included. Transvaginal port access was obtained via posterior colpotomy, and was used for dissection, vascular ligation, bowel division, and anastomosis. We used a combination of standard laparoscopic, minilaparoscopic, and needlescopic instruments transabdominally, focusing on reduced size and number of access points. Results: Duration of laparoscopy, oncologic outcomes and rate of operative morbidity were comparable to the published literature. Early return of gastrointestinal function and low analgesic requirements was observed in all patients. No morbidity related to transvaginal access was observed and the procedure was performed without difficulty in all cases. Conclusion: Colonic resection performed by hybrid natural-orifice technique offers several advantages over purely transabdominal laparoscopic procedures. Transvaginal access is easy to perform and offers excellent safety, efficacy, and versatility, especially for right hemicolectomy. Techniques to reduce abdominal wall surgical trauma, such as minilaparoscopy and needlescopic graspers, can be combined effectively in colonic resections, and may act synergistically to reduce postoperative pain and improve outcomes.
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Affiliation(s)
- Jayson M Moloney
- Department of General Surgery, Barwon Health, Geelong, Victoria, Australia
| | - Philip S L Gan
- Department of General Surgery, Southwest Healthcare, Warrnambool, Victoria, Australia
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Less pain after transvaginal cholecystectomy: single-center pooled analysis. Surg Endosc 2016; 31:2573-2576. [DOI: 10.1007/s00464-016-5263-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 09/20/2016] [Indexed: 12/18/2022]
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16
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Lukovich P, Sionov VB, Kakucs T. Training With Curved Laparoscopic Instruments in Single-Port Setting Improves Performance Using Straight Instruments: A Prospective Randomized Simulation Study. JOURNAL OF SURGICAL EDUCATION 2016; 73:348-354. [PMID: 26868318 DOI: 10.1016/j.jsurg.2015.10.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2015] [Revised: 10/10/2015] [Accepted: 10/20/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVE Lately single-port surgery is becoming a widespread procedure, but it is more difficult than conventional laparoscopy owing to the lack of triangulation. Although, these operations are also possible with standard laparoscopic instruments, curved instruments are being developed. The aims of the study were to identify the effect of training on a box trainer in single-port setting on the quality of acquired skills, and transferred with the straight and curved instruments for the basic laparoscopic tasks, and highlight the importance of a special laparoscopic training curriculum. DESIGN A prospective study on a box trainer in single-port setting was conducted using 2 groups. Each group performed 2 tasks on the box trainer in single-port setting. Group-S used conventional straight laparoscopic instruments, and Group-C used curved laparoscopic instruments. Learning curves were obtained by daily measurements recorded in 7-day sessions. On the last day, the 2 groups changed instruments between each other. SETTING 1st Department of Surgery, Semmelweis University of Medicine from Budapest, Hungary, a university teaching hospital. PARTICIPANTS In all, 20 fifth-year medical students were randomized into 2 groups. None of them had any laparoscopic or endoscopic experience. Participation was voluntary. RESULTS Although Group-S performed all tasks significantly faster than Group-C on the first day, the difference proved to be nonsignificant on the last day. All participants achieved significantly shorter task completion time on the last day than on the first day, regardless of the instrument they used. Group-S showed improvement of 63.5%, and Group-C 69.0% improvement by the end of the session. After swapping the instruments, Group-S reached significantly higher task completion time with curved instruments, whereas Group-C showed further progression of 8.9% with straight instruments. CONCLUSIONS Training with curved instruments in a single-port setting allows for a better acquisition of skills in a shorter period. For this reason, there is a need for proficiency-based conventional, but also for a single-port, laparoscopic training curriculum in general surgery residency education.
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Affiliation(s)
- Peter Lukovich
- 1st Department of Surgery, Semmelweis University, Budapest, Hungary.
| | | | - Timea Kakucs
- 1st Department of Surgery, Semmelweis University, Budapest, Hungary
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Gaillard M, Tranchart H, Lainas P, Dagher I. New minimally invasive approaches for cholecystectomy: Review of literature. World J Gastrointest Surg 2015; 7:243-248. [PMID: 26523212 PMCID: PMC4621474 DOI: 10.4240/wjgs.v7.i10.243] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 07/31/2015] [Accepted: 09/16/2015] [Indexed: 02/06/2023] Open
Abstract
Laparoscopic cholecystectomy is the most commonly performed abdominal intervention in Western countries. In an attempt to reduce the invasiveness of the procedure, surgeons have developed single-incision laparoscopic cholecystectomy (SILC), minilaparoscopic cholecystectomy (MLC) and natural orifice transluminal endoscopic surgery (NOTES). The aim of this review was to determine the role of these new minimally invasive approaches for elective laparoscopic cholecystectomy in the treatment of gallstone related disease. Current literature remains insufficient for the correct assessment of emerging techniques for laparoscopic cholecystectomy. None of these procedures has demonstrated clear benefits over conventional laparoscopic cholecystectomy. SILC cannot be currently recommended as it can be associated with an increased risk of bile duct injury and incisional hernia incidence. NOTES cholecystectomy is still experimental, although hybrid transvaginal cholecystectomy is gaining popularity in clinical practice. As it is standardized and almost identical to the standard laparoscopic technique, MLC could lead to limited benefits without exposing patients to increased postoperative complications, being therefore adoptable for routine elective cholecystectomy. Technical challenges of SILC and NOTES cholecystectomy could be addressed with the evolution of new surgical tools that need to catch up with the innovative minds of surgeons. Regardless the place of these approaches in the future, robotization may be necessary to impose them as standard treatment.
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Bulian DR, Knuth J, Lehmann KS, Sauerwald A, Heiss MM. Systematic analysis of the safety and benefits of transvaginal hybrid-NOTES cholecystectomy. World J Gastroenterol 2015; 21:10915-10925. [PMID: 26478683 PMCID: PMC4600593 DOI: 10.3748/wjg.v21.i38.10915] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2015] [Revised: 07/21/2015] [Accepted: 09/14/2015] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate transvaginal hybrid-NOTES cholecystectomy (TVC) during its clinical establishment and compare it with the traditional laparoscopic technique (LC).
METHODS: The specific problems and benefits of TVC were reviewed using a registry analysis, a comparative cohort study and a randomized clinical trial. At first, feasibility, safety and specific complications of the TVC were analyzed based on the first 488 data sets of the German NOTES Registry (GNR). Hereafter, we compared the early postoperative results of our first 50 TVC-patients with those of 50 female LC-patients matched by age, BMI and ASA classification. The same cohort was contacted an average of two years later to evaluate long-term results concerning pain and satisfaction with the aesthetic results and the overall postoperative results as well as sexual intercourse by means of two domains of the German version of the Female Sexual Function Index (FSFI-d). Consequently, we performed a randomized clinical trial comparing 20 TVC-patients with 20 needlescopic/3-trocar cholecystectomies (NC) also concerning the early postoperative results as well as pain, satisfaction and quality of life by means of the Eypasch Gastrointestinal Quality of Life Index (GIQLI) in the later course. Finally, we discussed the results in accordance with other published studies.
RESULTS: The complication (3.5%) and conversion rates (4.1%) for TVC were low in the GNR and comparable to those of the LC. Access related intraoperative complications included injuries to the bladder (n = 4; 0.8%) and bowel (n = 3; 0.6%). The study cohort revealed less postoperative pain after TVC comparing to the LC-patients on the day of surgery (NRS, 1.5/10 vs 3.1/10, P = 0.003), in the morning (NRS, 1.9/10 vs 2.8/10, P = 0.047) and in the evening (NRS, 1.1/10 vs 1.8/10, P = 0.025) of postoperative day (POD) one. The randomized clinical trial consistently found less cumulative pain until POD 2 (NRS, 8/40 vs 14/40, P = 0.043), as well as until POD 10 (NRS, 22/190 vs 41/190, P = 0.010). Furthermore, the TVC-patients had a better quality of life on POD 10 than did the LC-patients (GIQLI, 124/144 vs 107/144, P = 0.028). The complication rates were comparable and no specific problems were detected in the long-term follow-up for sexual intercourse for either group. The TVC-patients were more satisfied with the aesthetic result in the long-term course in the matched cohort analysis (1.00 vs 1.88, P < 0.001) as well as in the randomized clinical trial (1.00 vs 1.70, P < 0.001) when compared with the LC-patients.
CONCLUSION: TVC is a feasible procedure with a high safety profile and has advantages in regard to postoperative pain and aesthetic results when compared with LC or NC.
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Atallah S, Martin-Perez B, Keller D, Burke J, Hunter L. Natural-orifice transluminal endoscopic surgery. Br J Surg 2015; 102:e73-92. [PMID: 25627137 DOI: 10.1002/bjs.9710] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Accepted: 10/20/2014] [Indexed: 02/06/2023]
Abstract
BACKGROUND Natural-orifice transluminal endoscopic surgery (NOTES) represents one of the most significant innovations in surgery to emerge since the advent of laparoscopy. A decade of progress with this approach has now been catalogued, and yet its clinical application remains controversial. METHODS A PubMed search was carried out for articles describing NOTES in both the preclinical and the clinical setting. Public perceptions and expert opinion regarding NOTES in the published literature were analysed carefully. RESULTS Two hundred relevant articles on NOTES were studied and the outcomes reviewed. A division between direct- and indirect-target NOTES was established. The areas with the most promising clinical application included direct-target NOTES, such as transanal total mesorectal excision and peroral endoscopic myotomy. The clinical experience with distant-target NOTES, such as for appendicectomy and cholecystectomy, showed feasibility; however, NOTES-specific morbidity was introduced and this represents an important limitation. CONCLUSION NOTES experimentation in the preclinical setting has increased substantially. There has also been a significant increase in the application of NOTES in humans in the past decade. Enthusiasm for NOTES should be tempered by the risk of incurring NOTES-specific morbidity. Surgeons should carefully consider patient preferences regarding this new minimally invasive option, as opinions are not unanimously supportive of NOTES. As technical limitations are overcome, the clinical application of NOTES is predicted to increase. It is paramount that, when this complex technique is performed on humans, it is applied judiciously by appropriately trained experts with outcomes recorded in a registry.
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Affiliation(s)
- S Atallah
- Department of Colon and Rectal Surgery, Florida Hospital, Orlando, Florida
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Comprehensive complication index for NOTES procedures: results from a randomized controlled trial and comparison to published NOTES complication data. Surg Endosc 2014; 29:2928-33. [PMID: 25539692 DOI: 10.1007/s00464-014-4023-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Accepted: 12/02/2014] [Indexed: 01/01/2023]
Abstract
OBJECTIVE This investigation uses the comprehensive complication index (CCI) to compare complications after natural orifice transluminal endoscopic surgery (NOTES) procedures. BACKGROUND NOTES procedures are developed to miniaturize surgical trauma. NOTES publications inconsistently report complications. The CCI improves reporting of complications. METHODS The CCI is calculated using complication data from a single center, double blind, randomized controlled trial comparing transvaginal [transvaginal cholecystectomy (TVC), N = 41] and conventional laparoscopic cholecystectomy (CLC, N = 51). Complications are assessed using the classification of surgical complications (CSC). Two different scenarios are applied to the CSC for definition of complications with an emphasis on minor complications. CSC data are fed into the free online CCI-calculator. The CCIs from complication data from other NOTES reports are calculated accordingly and compared to our results. RESULTS The CCI allows easy indexing of complications with or without a CSC table. For scenario I, the mean CCI of CLC versus TVC is 3.3 (± 6.3; SD) versus 3.5 (± 6.4; n.s.) and for scenario II it is 7.6 (± 6.4) versus 6.5 (± 7.0; n.s.). The difference of the mean between the two scenarios is highly significant (p < 0.000). The mean CCIs of both groups and scenarios are below the CCI of 8.7 for a grade I CSC complication. Similar calculation of CCIs from other NOTES publications yields mean CCIs below 8.7 for the surgical procedures reported. CONCLUSION The CCI results in a single, easily comparable complication index for surgical procedures whereas the CSC yields tabular results. A significant difference in interpretation occurs with variation in definition of complications. Average CCIs below a value of 10 describe low complication rates. Authors need to describe their definition of complications if using the CSC and the CCI. More emphasis should be given to reporting of minor complications. The use of the CCI for NOTES procedures will enable international comparison.
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Sodergren MH, Markar S, Pucher PH, Badran IA, Jiao LR, Darzi A. Safety of transvaginal hybrid NOTES cholecystectomy: a systematic review and meta-analysis. Surg Endosc 2014; 29:2077-90. [PMID: 25424364 DOI: 10.1007/s00464-014-3915-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Accepted: 09/08/2014] [Indexed: 12/17/2022]
Abstract
BACKGROUND Despite increasing data regarding clinical outcomes following transvaginal hybrid NOTES cholecystectomy (TVC), a consensus regarding safety based on comparative studies has yet to be reached. The aim of this systematic review and meta-analysis was to compare safety and clinical outcomes of TVC with conventional laparoscopic cholecystectomy (CLC) for the treatment of benign gallstone disease. METHODS A comprehensive search for published studies comparing TVC and CLC was performed. Review of each study was conducted and data were extracted. All pooled outcome measures were determined using random-effects models. RESULTS Data were retrieved from 14 studies describing 1,145 patients. There was no difference in total complications (POR = 0.68; 95 % CI 0.40-1.14; P = 0.14), incidence of bile duct injury (POR = 1.33; 95 % CI 0.31-5.66; P = 0.70), Clavien-Dindo Grade II (POR = 0.48; 95 % CI 0.14-1.60; P = 0.23) or Grade III (POR = 0.63; 95 % CI 0.24-1.65; P = 0.34) complications between TCV and CLC. Time of return to normal activities was significantly reduced in the TVC group (WMD = -4.86 days; 95 % CI -9.33 to -0.39; P = 0.03), and there was a non-significant reduction in postoperative pain on days 1 (WMD = -0.80; 95 % CI -1.60 to 0.01; P = 0.05) and 3 (WMD = -0.89; 95 % CI -1.77 to -0.01; P = 0.05). CONCLUSIONS TVC is safe when performed by appropriately trained surgeons and may be associated with a faster return to normal activities and decreased postoperative pain.
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Affiliation(s)
- Mikael H Sodergren
- Department of Surgery and Cancer, St Mary's Hospital, Imperial College London, London 10th Floor QEQM Building, St. Mary's Hospital South Wharf Road, London, W2 1NY, UK,
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Senft JD, Warschkow R, Diener MK, Tarantino I, Steinemann DC, Lamm S, Simon T, Zerz A, Müller-Stich BP, Linke GR. The transvaginal hybrid NOTES versus conventionally assisted laparoscopic sigmoid resection for diverticular disease (TRANSVERSAL) trial: study protocol for a randomized controlled trial. Trials 2014; 15:454. [PMID: 25414061 PMCID: PMC4246541 DOI: 10.1186/1745-6215-15-454] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Accepted: 11/07/2014] [Indexed: 12/12/2022] Open
Abstract
Background Natural orifice transluminal endoscopic surgery (NOTES) is the consequence of further development of minimally invasive surgery to reduce abdominal incisions and surgical trauma. The potential benefits are expected to be less postoperative pain, faster convalescence, and reduced risk for incisional hernias and wound infections compared to conventional methods. Recent clinical studies have demonstrated the feasibility and safety of transvaginal NOTES, and transvaginal access is currently the most frequent clinically applied route for NOTES procedures. However, despite increasing clinical application, no firm clinical evidence is available for objective assessment of the potential benefits and risks of transvaginal NOTES compared to the current surgical standard. Methods The TRANSVERSAL trial is designed as a randomized controlled trial to compare transvaginal hybrid NOTES and laparoscopic-assisted sigmoid resection. Female patients referred to elective sigmoid resection due to complicated or reoccurring diverticulitis of the sigmoid colon are considered eligible. The primary endpoint will be pain intensity during mobilization 24 hours postoperatively as measured by the blinded patient and blinded assessor on a visual analogue scale (VAS). Secondary outcomes include daily pain intensity and analgesic use, patient mobility, intraoperative complications, morbidity, length of stay, quality of life, and sexual function. Follow-up visits are scheduled 3, 12, and 36 months after surgery. A total sample size of 58 patients was determined for the analysis of the primary endpoint. The confirmatory analysis will be performed based on the intention-to-treat (ITT) principle. Discussion The TRANSVERSAL trial is the first study to compare transvaginal hybrid NOTES and conventionally assisted laparoscopic surgery for colonic resection in a randomized controlled setting. The results of the TRANSVERSAL trial will allow objective assessment of the potential benefits and risks of NOTES compared to the current surgical standard for sigmoid resection. Trial registration The trial protocol was registered in the German Clinical Trials Register (
DRKS00005995) on March 27, 2014. Electronic supplementary material The online version of this article (doi:10.1186/1745-6215-15-454) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Georg R Linke
- Department of General, Abdominal and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany.
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Federlein M, Müller V, Fritze-Büttner F, Burghardt J, Gräber S, Gellert K, Borchert D. Transvaginale Cholezystektomie. Chirurg 2014; 85:825-32. [DOI: 10.1007/s00104-014-2852-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Transvaginal hybrid NOTES cholecystectomy--results of a randomized clinical trial after 6 months. Langenbecks Arch Surg 2014; 399:717-24. [PMID: 24952726 DOI: 10.1007/s00423-014-1218-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Accepted: 06/15/2014] [Indexed: 02/07/2023]
Abstract
INTRODUCTION For cholecystectomy (CHE), both the needlescopic three-trocar technique with 2-3-mm instruments (needlescopic cholecystectomy (NC)) and the umbilically assisted transvaginal technique with rigid instruments (transvaginal cholecystectomy (TVC)) have been established for further reduction of the trauma remaining from laparoscopy. METHODS To compare the further outcome of both techniques for elective CHE in female patients, we analyzed the secondary end points of a prospective randomized single-center trial (needlescopic versus transvaginal cholecystectomy (NATCH) trial; ClinicalTrials.gov Identifier: NCT0168577), in particular, satisfaction with aesthetics, overall satisfaction, abdominal pain, and incidence of trocar hernias postoperatively at both 3 and 6 months. After 3 months, the domains "satisfaction" and "pain" of the German version of the Female Sexual Function Index (FSFI-d) were additionally evaluated to detect respective complications. A gynecological control examination was conducted in all TVC patients after 6 months. RESULTS Forty patients were equally randomized into the therapy and the control groups between February 2010 and June 2012. No significant differences were found for overall satisfaction with the surgical result, abdominal pain, sexual function, and the rate of trocar hernias. However, aesthetics were rated significantly better by TVC patients both after 3 and after 6 months (P = 0.004 and P < 0.001). There were no postoperative pathological gynecological findings. CONCLUSIONS Following TVC, there is a significantly better aesthetic result as compared to NC, even at 3 and 6 months after the procedure. No difference was found for sexual function.
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