NOTES Technique: Tranvesical Access

Aim : The transvesical access in NOTES surgery is one of the alternatives which is regarded safe, effective with a minimal risk of peritoneal infection. However, a careful urinary bladder closure is the major difficulty. Our team found a new, secure method for a transvesical application of NOTES. Methods: In the studies a schwine model was used (4 females of the pigs). While pigs were in general anesthesia, with the help of a flexible cystoscope (15Fr), an endoscopic bladder incision was made in order to explore peritoneum. Biopsies were performed and hemostasis was provided. Finally, the wound was closed with the Vicryl loop. In a two week period, all pigs were euthanized and underwent pathological examination. Results: There was no bowler injury in any case. Bladder was closed in an enough good manner in two cases, partial closure was achieved in one pig. After the surgery, all pigs were in a good state, painless, with a good appetite. On pathomorfological exam no intraabdominal adhesions were observed, all pigs presented a healed opening site with lack of any adhesion. Conclusion: Newly developed method has many advantages and provides good orientation in the surgical field as well as good pelvis management. Neither the biopsies nor the hemostasis was a problem. It is the first report of this method of bladder closure but further studies need to be done in order to spread this technique into people. Authors: Jasneet Singh Bhullar, MD, Gokulakkrishna Subhas, MD, Aditya Gupta, Jonathan Cook, Michael J. Jacobs, MD, Boris Silberberg, MD, Lee Andrus, LVT, Melissa Decker, LVT, Vijay K. Mittal, MD, FACS