774 TRANSGASTRIC NOTES TM PARTIAL CYSTECTOMY: A PROSPECTIVE CHRONIC PORCINE STUDY (2011)

You have accessJournal of UrologyTechnology & Instruments: Robotics/Laparoscopy1 Apr 2011774 TRANSGASTRIC NOTESTM PARTIAL CYSTECTOMY: A PROSPECTIVE CHRONIC PORCINE STUDY Mark D. Sawyer, Irma Lengu, Matthew Steinway, Jeffrey Marks, Wenbin Xiao, Gregory MacLennan, Steve Schomisch, Joseph Trunzo, and Lee E. Ponsky Mark D. SawyerMark D. Sawyer Cleveland, OH More articles by this author , Irma LenguIrma Lengu Cleveland, OH More articles by this author , Matthew SteinwayMatthew Steinway Cleveland, OH More articles by this author , Jeffrey MarksJeffrey Marks Cleveland, OH More articles by this author , Wenbin XiaoWenbin Xiao Cleveland, OH More articles by this author , Gregory MacLennanGregory MacLennan Cleveland, OH More articles by this author , Steve SchomischSteve Schomisch Cleveland, OH More articles by this author , Joseph TrunzoJoseph Trunzo Cleveland, OH More articles by this author , and Lee E. PonskyLee E. Ponsky Cleveland, OH More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.1813AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Natural Orifice Translumenal Endoscopic Surgery (NOTESTM) uses a natural orifice to access the peritoneum. Clinical transgastric NOTES procedures have been described, but not in Urology. After demonstrating feasibility of transgastric NOTES partial cystectomy in an acute model, our group initiated a prospective chronic porcine study to evaluate outcomes and pathologic healing of the bladder closure. METHODS This IACUC approved study was intended to include ten animals for a two week survival period. All procedures were performed under anesthesia with antibiotics administered prior in a dedicated OR suite. After making a gastrotomy, the peritoneum was accessed using a specialized gastroscope (R-ScopeTM). A cystoscope was used to make the bladder lesion with electrocautery. In the first 7 pigs, our technique was to place two endoscopic loops and incise between loops leaving both bladder and specimen sealed. The specimen was removed orally. Closure was reinforced with endoscopic clips. Subsequently, technique was modified to emphasize closure by simply excising specimen and using a gastroscope suture device (OverStitch™) (n=2) and/or a series of clips on each edge of the defect that are approximated in pairs using endoscopic loops (n=1). This clip-clip-loop technique was used for gastrotomy closure. Postoperatively, animals were monitored per protocol until 2 week necropy. Preserved bladders were assessed histologically for healing. RESULTS The intended procedure was completed in 10 chronic animals (μ=34.5kg). All survived the immediate procedure. Operative time was 135–360min (μ=233) with mean EBL=11.5mL. Mean margin was 2.3 cm (σ=0.45). In 7/10, all 4 margins were ≥2cm. Mean specimen size was 30.7 cm2 (σ=10.8). Of the first 7, 4 survived to the endpoint (57%). Three were euthanized (days 4, 10 and 11) and on necropsy had diffuse peritonitis with open bladder defects but sealed stomachs. Our veterinarian required a change in bladder closure to continue. Two alternative bladder closure techniques were devised (see methods). After the change, subsequent animals (n=3) appeared healthy at necropsy (100%). Histology demonstrated incomplete healing, likely reflecting inadequate survival time. CONCLUSIONS This transgastric NOTES partial cystectomy study demonstrated need to re-evaluate initial bladder closure models as outcomes from our initial approach were unacceptable. However, survival of the last three animals with new closure techniques is encouraging. Further development and evaluation of these closure techniques is required before true feasibility can be assessed. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e311-e312 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Mark D. Sawyer Cleveland, OH More articles by this author Irma Lengu Cleveland, OH More articles by this author Matthew Steinway Cleveland, OH More articles by this author Jeffrey Marks Cleveland, OH More articles by this author Wenbin Xiao Cleveland, OH More articles by this author Gregory MacLennan Cleveland, OH More articles by this author Steve Schomisch Cleveland, OH More articles by this author Joseph Trunzo Cleveland, OH More articles by this author Lee E. Ponsky Cleveland, OH More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...