Transvaginal cholecystectomy with endoscopic submucosal dissection instruments and single-channel endoscope: a survival study in porcine model.

Abstract

BACKGROUND: Natural orifice transluminal endoscopic surgery has received much attention in recent years. Instead of using prototype devices, we explored the feasibility and practicability of using readily available off-the-shelf devices to perform Natural Orifice Transluminal Endoscopic Surgery in an animal model. METHODS: Twenty pigs underwent transvaginal cholecystectomy, 16 of which were used for surviving study after the procedure. A single-channel endoscope and standard instruments for endoscopic submucosal dissection (hook knife and Insulated Tip knife) were used for cholecystectomy. A single 5-mm laparoscopic port was inserted for gallbladder retraction. RESULTS: Completion of the procedure was achieved in all 20 pigs. In 16 pigs, which were used for surviving study after surgery, 15 survived. Death of 1 pig was due to leakage of urine from the colpotomy and urogenital sinus. Technical success was achieved in the access, dissection, and retrieval of specimen in all the animals. CONCLUSIONS: A hybrid approach with single-channel endoscope together with endoscopic submucosal dissection instruments for transvaginal cholecystectomy was shown to be safe and feasible in this pig model and this serves as a good training model before application of this technique in human. A distinct pattern of complications was identified and needed to be addressed.