Rigid and flexible endoscopic rendezvous in spatium peritonealis may be an effective tactic for laparoscopic megasplenectomy: significant implications for pure natural orifice translumenal endoscopic surgery
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- 作者：Morimasa Tomikawa (1)
Tomohiko Akahoshi (2)
Nao Kinjo (3)
Hideo Uehara (3)
Naotaka Hashimoto (3)
Yoshihiro Nagao (1)
Masahiro Kamori (3)
Ryuichi Kumashiro (3)
Yoshihiko Maehara (3)
Makoto Hashizume (2) - 关键词：Laparoscopic splenectomy ; Flexible endoscope ; Natural orifice translumenal endoscopic surgery (NOTES)
- 刊名：Surgical Endoscopy
- 出版年：2012
- 出版时间：December 2012
- 年：2012
- 卷：26
- 期：12
- 页码：3573-3579
- 全文大小：639KB
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16. Tomikawa M, Xu H, Hashizume M (2010) Current status and prerequisites for natural orifice translumenal endoscopic surgery (NOTES). Surg Today 40:909鈥?16 CrossRef - 作者单位：Morimasa Tomikawa (1)
Tomohiko Akahoshi (2)
Nao Kinjo (3)
Hideo Uehara (3)
Naotaka Hashimoto (3)
Yoshihiro Nagao (1)
Masahiro Kamori (3)
Ryuichi Kumashiro (3)
Yoshihiko Maehara (3)
Makoto Hashizume (2)
1. Department of Advanced Medicine and Innovative Technology, Kyushu University Hospital, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
2. Department of Advanced Medical Initiatives, Faculty of Medical Sciences, Kyushu University, Fukuoka, 812-8582, Japan
3. Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, 812-8582, Japan - ISSN：1432-2218
文摘
Background We recently experienced 10 patients with cirrhosis who underwent laparoscopic splenectomy. A portion of these patients underwent dissection with a flexible endoscope in the peritoneal cavity. This pilot study mainly focused on the technical aspects and immediate results. Methods From November 2009 to September 2010, 10 patients with cirrhosis and hypersplenism were entered into this pilot study. They were indicated to undergo laparoscopic splenectomy to treat portal hypertension and to facilitate initiation and completion of either interferon therapy for liver cirrhosis or anticancer therapy for hepatocellular carcinoma. To dissect the upper end of the gastrosplenic ligament and the marginal region between the left diaphragm and upper pole of the spleen, a flexible single-channel endoscope was introduced into the peritoneal cavity simultaneously with the use of a rigid laparoscope. Dissection with the flexible endoscope in the peritoneal cavity was performed using an insulation-tipped electrosurgical knife through the channel of the flexible endoscope. Results The flexible endoscope offered a magnified operative view, a water-jet lens cleaner, and a powerful lavage and suction capability. The upper end of the gastrosplenic ligament and the marginal region between the left diaphragm and upper pole of the spleen were easily seen, and dissection of these critical regions was smoothly conducted with articulation of the tip of the flexible endoscope, even in patients with splenomegaly. No patient experienced major intraoperative complications or required conversion to open surgery. Conclusions Dissection with a flexible endoscope in the peritoneal cavity may be an effective tactic for laparoscopic megasplenectomy, and significant implications for pure natural orifice translumenal endoscopic surgery have been raised. Although future randomized controlled prospective studies are needed to confirm these findings, surgeons might find this to be a typical example of an appropriate strategy for high-risk patients.