SOBRACIL

Newsletter Sobracil-SP vol 2; 2007

Daniel A Tsin, Liliana T Colombero, Johann Lambeck, Panagiotis Manolas
Minilaparoscopy-assisted Natural Orifice Surgery.

JSLS: Journal of the Society of Laparoendoscopic Surgeons / Society of Laparoendoscopic Surgeons - 2007 vol. 11 pp. 24-9.
The Mount Sinai Hospital of Queens, Department of Minimally Invasive Surgery, Long Island City, New York 11102, USA. LaserGYN@aol.com

BACKGROUND AND OBJECTIVES: New technology has allowed us to perform major abdominal and pelvic surgeries with increasingly smaller instruments. The ultimate goal is surgery with no visible scars. Until current technical limitations are overcome, minilaparoscopy-assisted natural orifice surgery (MANOS) provides a solution. The aim of this study was to examine our clinical and experimental experience with MANOS. METHOD: Minilaparoscopic abdominal instruments were used together with a large vaginal port, which was used for insufflation, visual purposes, introduction of operative instruments, and specimen extraction. Minilaparoscopy-assisted intraperitoneal transgastric appendectomy was done in simulators (Lap trainer with SimuVision, Simulab Corp., Seattle, WA). RESULTS: Since 1998, we have used this technique in 100 cases including ovarian cystectomies, oophorectomies, salpingo-oophorectomies, myomectomies, appendectomies, and cholecystectomies. Some oophorectomies were performed after vaginal hysterectomy in cases where vaginal extraction was not possible. In this case series, we had only one complication, a case of postoperative fever after an ovarian cystectomy, which was diagnosed as drug-related fever. Our limited simulator experience showed that MANOS is a feasible technique for performing transgastric appendectomies. CONCLUSION: It may take several years for natural orifice surgery to become standard care. Meanwhile, MANOS could encourage and expedite this process.

Comentários: O presente trabalho situa o momento de transição entre a videolaparoscopia e a realização de procedimentos cirúrgicos através de orifícios naturais (NOTES).Ressalte-se que no início deveremos ter procedimentos realizados com a associação destas técnicas, sugerindo um procedimento hibrido com o acesso por orificios naturais e um suporte pela minilaparoscopia o que aumentaria a segurança do ato até que se viabilizem instrumentos apropriados. Neste trabalho os autores referem experiência em 100 casos desde 1998 realizando procedimentos cirúrgicos transvaginais combinados, alem de experiência em simuladores realizando acesso peritoneal transgástrico.

Alexander Morrell (morrell@uol.com.br)