A pilot Study on Pure NOTES: Endoscopic Colon Resection and Anastomosis in a Porcine Model

Aims The field of surgical technology is evolving due to Natural Orifice Transluminal Endoscopic Surgery (NOTES), which offers less invasive methods. This shift eliminates the need for external incisions, as seen in procedures like cholecystolithotomy through the gastrointestinal tract. Benefits include less postoperative pain, lower infection risks, and faster recovery. While traditional surgeries require abdominal incisions for specimen retrieval, Natural Orifice Specimen Extraction Surgery (NOSES) allows for extraction through natural routes, reducing trauma. Advances in endoscopic techniques have also made full-thickness resections feasible. However, before this study, a complete intestinal resection with endoscopic anastomosis using NOTES protocols was not performed. Our study aims to achieve a segmental intestinal resection without external scars, marking a significant advancement in minimally invasive surgery.

Methods The study involved three pigs, each prepared with a three-day fasting regimen and positioned with a removable balloon in the transverse colon. The endoscopic procedure employed a state-of-the-art gastroscope, executing circular full-thickness incisions along the colon, followed by isolation and resection of a colonic segment. End-to-end anastomosis was performed using nylon loops and clips to ensure stable reattachment of the resected intestinal ends.

Results The average procedural duration was 249.3 minutes with no significant complications, indicating the feasibility and safety of this endoscopic approach. Postoperative care included a transition from glucose solutions to a standard diet over seven days, alongside penicillin administration, ensuring patient recovery and normal defecation.

Conclusions In conclusion, our study advances the field of minimally invasive surgery by demonstrating a successful pure NOTES technique for endoscopic colon resection and anastomosis in a porcine model. It offers a glimpse into the future of surgical procedures, where the emphasis on reducing patient trauma and enhancing recovery could redefine the standards of care for gastrointestinal surgeries. While promising, the realization of its full potential in clinical practice necessitates further experimental and clinical validation.

Publication History

Article published online:
27 March 2025