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Transgastric and Transperineal Natural Orifice Translumenal Endoscopic Surgery (NOTES) in an Appendectomy Test Bed

Canadian Surgical Technologies & Advanced Robotics, Lawson Health Research Institute

Christopher M. Schlachta, MD CM, FRCS(C), FACS

Department of Surgery, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada, christopher.schlachta{at}lhsc.on.ca

Introduction. Our purpose was to establish a NOTES appendectomy test bed to evaluate whether the transgastric or transperineal (transvaginal) approach is most efficient. Methods. Using the uterine horns of female pigs as a model for appendectomy, 18 NOTES appendectomies were performed in 2 arms: 9 transgastric and 9 transvaginal. The primary outcome was mean total operative time for each technique excluding access closure. Secondary outcomes were peritoneal access and resection times. Means were compared using Student’s t-test. Results. Transgastric cases were faster than transperineal (46.5 ± 14.5 vs 60.0 ± 20.2 minutes, P = .02). Most of the improvement in transgastric times was due to faster resection (37.9 ± 17.4 vs 51.3 ± 16.5 minutes, P = .03). Neither approach was faster for peritoneal access (8.2 ± 3.4 vs 8.3 ± 4.5 minutes, nonsignificant). A significant learning curve was not demonstrated for the transgastric approach (53.0 vs 40.3 minutes, nonsignificant). A significant learning curve was demonstrated for the transperineal approach (76.0 vs 46.7 minutes, P = .02). Transperineal times improved over the study and approached transgastric; however, the last three transgastric cases were still significantly faster than the last three transperineal (40.3 vs 46.7 minutes, P = .02). No complications occurred in either group. Conclusions. The transgastric as compared with transperineal approach to NOTES appendectomy resulted in improved operative time in this model. The transperineal approach demonstrated a significant learning curve with operative times between techniques converging over time. This NOTES appendectomy test bed is suitable for evaluating NOTES innovations.

Key Words: NOTES • appendectomy • endoscopy • transgastric approach • transperineal approach

This version was published on September 1, 2009

Surgical Innovation, Vol. 16, No. 3, 223-227 (2009)
DOI: 10.1177/1553350609342076


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