Browsing by Author "PÊGO, J.M."
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- Third‐generation nephrectomy by natural orifice transluminal endoscopic surgeryPublication . LIMA, E.; ROLANDA, C.; PÊGO, J.M.; HENRIQUES‐COELHO, T.; SILVA, D.; OSÓRIO, L.; MOREIRA, I.; CARVALHO, J.L.; CORREIA‐PINTO, J.Urol. 2007 Dec;178(6):2648-54. Epub 2007 Oct 22. Third-generation nephrectomy by natural orifice transluminal endoscopic surgery. Lima E, Rolanda C, Pêgo JM, Henriques-Coelho T, Silva D, Osório L, Moreira I, Carvalho JL, Correia-Pinto J. Life and Health Sciences Research Institute, School of Health Sciences, University of Minho, Braga, Portugal. Abstract PURPOSE: Recently there has been increasing enthusiasm for performing simple abdominal procedures by transgastric surgery. We previously reported the usefulness of a combined transgastric and transvesical approach to cholecystectomy. In this study we assessed the feasibility of combined transgastric and transvesical approach for performing a more complex surgical procedure, such as nephrectomy, in a porcine model. MATERIALS AND METHODS: In a nonsurvival study combined transgastric and transvesical approaches were established in 6 female pigs. Under ureteroscope guidance we installed a transvesical 5 mm over tube into the peritoneal cavity and a flexible gastroscope was passed orally into the peritoneal cavity by a gastrotomy. We performed right or left nephrectomy with instruments introduced by the 2 devices that worked in the renal hilum, alternating device intervention for dissection and retraction procedures. RESULTS: Four right and 2 left nephrectomies were performed. There were no complications during the creation of transvesical and transgastric access. In all animals we visualized the 2 kidneys. The renal vessels and ureter were reasonably individualized and ligated separately with ultrasonic scissors, which were introduced through the transvesical port. In 2 early cases mild hemorrhage occurred after ultrasonic ligation. To overcome this complication we applied clips successfully before ultrasonic ligation in the remaining animals. Thus, complete renal release and mobilization to the stomach were achieved in all animals. CONCLUSIONS: Nephrectomy by natural orifices using the combined transgastric and transvesical approach is technically feasible, although to our knowledge there is no reliable method for removing the specimen with current instruments. PMID: 17945287 [PubMed - indexed for MEDLINE]
- Transvesical thoracoscopy: a natural orifice translumenal endoscopic approach for thoracic surgeryPublication . LIMA, E.; HENRIQUES‐COELHO, T.; ROLANDA, C.; PÊGO, J.M.; SILVA, D.; CARVALHO, J.L.; CORREIA‐PINTO, J.Surg Endosc. 2007 Jun;21(6):854-8. Epub 2007 May 4. Transvesical thoracoscopy: a natural orifice translumenal endoscopic approach for thoracic surgery. Lima E, Henriques-Coelho T, Rolanda C, Pêgo JM, Silva D, Carvalho JL, Correia-Pinto J. Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal. Abstract BACKGROUND: Recently there has been an increasing enthusiasm for using natural orifices translumenal endoscopic surgery (NOTES) to perform scarless abdominal procedures. We have previously reported the feasibility and safety of the transvesical endoscopic peritoneoscopy in a long-term survival porcine model as useful for those purposes. Herein, we report our successful experience performing transvesical and transdiaphragmatic endoscopic approach to the thoracic cavity in a long-term survival study in a porcine model. METHODS: Transvesical and transdiaphragmatic endoscopic thoracoscopy was performed in six anesthetized female pigs. A 5 mm transvesical port was created on the bladder wall and an ureteroscope was advanced into the peritoneal cavity. After diaphragm inspection, we introduced through the left diaphragmatic dome a ureteroscope into the left thoracic cavity. In all animals, we performed thoracoscopy as well as peripheral lung biopsy. Animals were sacrificed by day 15 postoperatively. RESULTS: We easily introduced a 9.8 Fr ureteroscope into the thoracic cavity that allowed us to visualize the pleural cavity and to perform simple surgical procedures such as lung biopsies without complications. There were neither respiratory distress episodes nor surgical complications to report. Postmortem examination revealed complete healing of vesical and diaphragmatic holes, whereas no signs of infection or adhesions were observed in the peritoneal or thoracic cavities. CONCLUSION: This study demonstrates the feasibility of transvesical thoracoscopy in porcine model. However, although this study extends the potential applications of NOTES to the thoracic cavity, new instruments and further work are needed to provide evidence that this could be translated to humans and with advantages for patients. PMID: 17479317 [PubMed - indexed for MEDLINE]