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ABSTRACT: BACKGROUND: Natural orifice transluminal endoscopic surgery (NOTES) procedures have been performed via transgastric, transvaginal, or transcolonic approaches. However, the transcolonic approach has potential disadvantages including intraperitoneal infection. To avoid such disadvantages, we applied the submucosal tunnel technique to transrectal peritoneal access in this study. Study aims are to clarify the technical feasibility of a submucosal tunnel method for transrectal abdominal access and to assess the healing process of the submucosal tunnel histopathologically. METHODS: The study comprised six female pigs. The following procedures were performed: (1) The mucosa was cut after injection of sodium hyaluronate into the submucosa at the upper rectum. (2) Submucosal tunneling was performed by endoscopic submucosal dissection technique. (3) A small incision was made at the end of the tunnel. (4) After transrectal peritoneoscopy, the mucosal incision site was closed with endoclips. RESULTS: Transrectal peritoneoscopy was successfully performed in all pigs. Necropsy revealed no findings of peritonitis. Histopathologic examination showed good healing of the submucosal tunnel. The wound healing process of the submucosal tunnel on postoperative day 7 was mainly in the inflammatory phase at the mucosal incision site, the proliferative phase at the submucosal tract, and the proliferative/remodeling phase at the seromuscular incision site. CONCLUSIONS: The submucosal tunnel technique appears to be useful and safe for transrectal peritoneal access because healing at the seromuscular incision site proceeded rapidly.
Surgical Endoscopy 06/2012; · 4.01 Impact Factor
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ABSTRACT: Introduction. Usefulness of submucosal tunneling for transgastric approach with clip closure of the mucosal incision in natural orifice translumenal endoscopic surgery (NOTES) has been described. Although the narrow longitudinal submucosal tunnel itself is considered good for wound approximation and healing, no reports have evaluated the sealing effect in this technique. This study was aimed at evaluating the technical feasibility of a submucosal tunnel technique for transgastric peritoneal access without mucosal closure. Methods. Transgastric peritoneoscopy using submucosal tunneling with endoscopic submucosal dissection without mucosal closure was performed on six 40- to 45-kg female pigs. Measures included (a) evaluation of technical feasibility, (b) clinical monitoring for 7 days, (c) necropsy findings, and (d) pathological examination. Results. NOTES transgastric peritoneoscopy was successfully performed in all pigs, and all recovered well clinically. Necropsy findings revealed no peritonitis, confirming completeness of gastric closure in 5 of the 6 pigs. One pig in which the submucosal layer of the tunnel was injured during dissection from the muscular layer showed local peritonitis. Pathological examination at the submucosal site tunnel showed wound healing with focal transmural fibrosis and inflammatory cell infiltration in 5 pigs, whereas the pig with peritonitis had a large mucosal defect with necrotic tissue, abscess formation, and focal transmural fibrosis. Conclusions. The submucosal tunnel technique without mucosal closure is safe and effective for transgastric peritoneal access and subsequent closure, when the endoscopists' learning curve is accomplished and the submucosal tunnel is produced without damaging of mucosa. It is necessary to use devices such as mucosal clips or tissue anchors in order to achieve adequate healing of mucosal defect.
Surgical Innovation 02/2012; · 2.13 Impact Factor
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ABSTRACT: Alopecia is one of the most common side effects of chemotherapy for which treatments have not been developed. In the present study, we evaluated the effects of sodium zinc dihydrolipoylhistidinate (DHLHZn), a new derivative of the multifunctional antioxidant α-lipoic acid, to treat chemotherapy-induced alopecia.
Wistar rats (8 days old) were treated with cytosine arabinoside (AraC; 20 mg/kg by daily intraperitoneal injection; days 0-6) and DHLHZn (0%, 0.5%, or 1% topically applied in a white petrolatum base; days 0-12). A control group received daily saline injections (days 0-6) and topical application of white petrolatum (days 0-12). On day 12, we evaluated hair loss and histologic changes to scalp tissue for each group (n = 10).
Rats treated with AraC and 0% DHLHZn cream exhibited complete hair loss; however, treatment with 0.5% or 1% DHLHZn significantly reduced chemotherapy-induced hair loss. Histological analysis revealed that AraC treatment promoted inflammatory cell infiltration of the hair follicles, but this inflammatory response was attenuated by DHLHZn.
Our findings demonstrate that DHLHZn attenuates chemotherapy-induced alopecia, indicating the potential use of this α-lipoic acid derivative as a therapeutic agent against this common side effect of chemotherapy.
Surgery Today 05/2011; 41(5):693-7. · 1.22 Impact Factor
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ABSTRACT: A few studies have addressed the physiology related to a basic natural-orifice transluminal endoscopy surgery (NOTES) procedure, such as transgastric peritoneoscopy, but the physiologic impact of more complex NOTES procedures has not been previously examined.
To evaluate the cardiopulmonary and immunologic effects of transvaginal NOTES cholecystectomy compared with laparoscopic cholecystectomy.
Survival experiments in 10 40-kg female pigs assigned to transvaginal cholecystectomy and laparoscopic cholecystectomy groups.
Transvaginal cholecystectomy was performed with the assistance of a needlescopic device, and laparoscopic cholecystectomy was performed in the standard manner.
Cardiopulmonary and immunologic parameters in the transvaginal cholecystectomy group were compared with those in the laparoscopic cholecystectomy group. Cardiopulmonary parameters included heart rate, blood pressure, saturation pulse oximetry, intratracheal pressure, and arterial blood gases. Immunologic parameters included white blood cell count, tumor necrosis factor-α, interleukin-1β, and interleukin-6.
All procedures were performed successfully without complications. Although operation times were longer for transvaginal cholecystectomy than for laparoscopic surgery, cardiopulmonary changes were similar and stable in both groups. White blood cell count, interleukin-1β, and interleukin-6 did not differ between the 2 groups, and the increase in tumor necrosis factor α after transvaginal cholecystectomy was significantly smaller on postoperative day 1 than after laparoscopic cholecystectomy (133.4 pg/mL vs 200.4 pg/mL; P < .05).
Animal model and small sample size.
Transvaginal cholecystectomy resulted in cardiopulmonary stability and well preserved immune function similar to those of laparoscopic cholecystectomy, suggesting that NOTES may be less invasive than laparoscopic surgery.
Gastrointestinal endoscopy 12/2010; 72(6):1241-8. · 6.71 Impact Factor
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ABSTRACT: Background: Many experimental studies have shown the technical feasibility of natural orifice translumenal endoscopic surgery (NOTES). We report the first clinical application of natural orifice transgastric endoscopic peritoneoscopy in Japan for preoperative staging in a patient with pancreatic cancer.Methods: A submucosal tunnel was created for safe peritoneal access and secure closure of the gastric-incision site.Results: Transgastric peritoneoscopy provided an excellent view and allowed approach to various areas of the abdominal cavity. After confirmation of operative curability, the patient underwent an open standard operation without complication.Conclusions: Natural orifice transgastric endoscopic peritoneoscopy for cancer staging using the submucosal tunnel technique appears to be feasible and safe.
Digestive Endoscopy 09/2008; 20(4):198 - 202. · 1.19 Impact Factor
