Transrectal access still has some unsolved issues such as spatial orientation,
infection, access and site closure. This study presents a simple technique to
perform transcolonic access with survival in a swine model series. A new
technique for NOTES perirectal access to perform retroperitoneoscopy,
peritoneoscopy, liver and lymphnode biopsies was performed in 6 pigs, using
Totally NOTES technique. The specimens were extracted transanally. The
flexible endoscope was inserted through a posterior transmural incision and
the retrorectal space. Cultures of bacteria were documented for the
retroperitoneal space and intra abdominal cavity after 14 days. Rectal site
was closed using non-absorbable sutures. There was no bowel cleansing, nor
preoperative fasting. The procedures were performed in 6 pigs through
transcolonic natural orifice access using available endoscopic flexible
instruments. All animals survived 14 days without complications, and cultures
were negative. Histopathologic examination of the rectal closure site showed
adequate healing of suture line and no micro abscesses. The results of
feasibility and safety of experimental Transcolonic NOTES potentially brings
new frontiers and future wider applications for minimally invasive surgery.
The treatment of colorectal, abdominal and retroperitoneal diseases through a
flexible Perirectal NOTES Access (PNA) is a promising new approach