Feasibility of transrectal hybrid natural orifice transluminal endoscopic surgery (NOTES) nephrectomy in the cadaveric model

Wassim M. Bazzi, Sean P. Stroup, Seth A. Cohen, Takayuki Dotai, Ryan Kopp, Caroline Colangelo, Omer A. Raheem, Sonia Ramamoorthy, Mark Talamini, Santiago Horgan, Christopher J. Kane, Ithaar H. Derweesh

Research output: Contribution to journalArticle

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Abstract

To examine feasibility of transrectal hybrid natural orifice transluminal endoscopic surgery (NOTES) nephrectomy in human cadavers in the evolution of this technique, as transrectal hybrid NOTES nephrectomy has been demonstrated in the porcine model. Four hybrid transrectal NOTES nephrectomies were performed on 4 cadavers (3 female/1 male, 2 right/2 left). Pneumoperitoneum was created by periumbilical 12-mm trocar, through which a laparoscope was advanced to obtain intra-abdominal visualization. A 4-cm horizontal incision was made 2-cm above the dentate line and a submucosal tunnel was created in the posterior rectal wall/presacral space. A dual-channel gastroscope was advanced through the submucosal tunnel and retroperitoneum to the level of the kidney using air insufflation. A peritoneal window was created and renal mobilization was completed. A transumbilically applied laparoscopic 45-mm stapler was used to transect the ureter and renal hilum. A specimen entrapment bag was deployed transrectally for specimen extraction, followed by transrectal incision closure. Transrectal NOTES nephrectomy was successfully performed in all cases, with intact specimen extraction. Median weight was 77 kg (range 74-85 kg); median body mass index (BMI) was 30.1 kg/m2 (range 25.6-31.2 kg/m 2). Mean operative time was 175 minutes (range 150-210 minutes). Median transrectal access time was 36 minutes (range 24-47 minutes). Median dimensions of removed kidneys were length 11.2 cm (range 10-12 cm), width 5 cm (range 4.5-6 cm), and thickness 3.8 cm (range 3-4.5 cm). Transrectal hybrid NOTES nephrectomy in the cadaver model is feasible with intact specimen extraction and acceptable operative times. Preclinical survival studies are requisite to assess sterility and complications. This approach may be an alternative to transvaginal access.

Original languageEnglish (US)
Pages (from-to)590-595
Number of pages6
JournalUrology
Volume80
Issue number3
DOIs
StatePublished - Sep 2012
Externally publishedYes

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Natural Orifice Endoscopic Surgery
Nephrectomy
Cadaver
Kidney
Operative Time
Gastroscopes
Laparoscopes
Insufflation
Pneumoperitoneum
Ureter
Surgical Instruments
Infertility
Body Mass Index
Swine
Air
Weights and Measures

ASJC Scopus subject areas

  • Urology

Cite this

Feasibility of transrectal hybrid natural orifice transluminal endoscopic surgery (NOTES) nephrectomy in the cadaveric model. / Bazzi, Wassim M.; Stroup, Sean P.; Cohen, Seth A.; Dotai, Takayuki; Kopp, Ryan; Colangelo, Caroline; Raheem, Omer A.; Ramamoorthy, Sonia; Talamini, Mark; Horgan, Santiago; Kane, Christopher J.; Derweesh, Ithaar H.

In: Urology, Vol. 80, No. 3, 09.2012, p. 590-595.

Research output: Contribution to journalArticle

Bazzi, WM, Stroup, SP, Cohen, SA, Dotai, T, Kopp, R, Colangelo, C, Raheem, OA, Ramamoorthy, S, Talamini, M, Horgan, S, Kane, CJ & Derweesh, IH 2012, 'Feasibility of transrectal hybrid natural orifice transluminal endoscopic surgery (NOTES) nephrectomy in the cadaveric model', Urology, vol. 80, no. 3, pp. 590-595. https://doi.org/10.1016/j.urology.2012.06.026
Bazzi, Wassim M. ; Stroup, Sean P. ; Cohen, Seth A. ; Dotai, Takayuki ; Kopp, Ryan ; Colangelo, Caroline ; Raheem, Omer A. ; Ramamoorthy, Sonia ; Talamini, Mark ; Horgan, Santiago ; Kane, Christopher J. ; Derweesh, Ithaar H. / Feasibility of transrectal hybrid natural orifice transluminal endoscopic surgery (NOTES) nephrectomy in the cadaveric model. In: Urology. 2012 ; Vol. 80, No. 3. pp. 590-595.
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