Brief Article
Copyright ©2011 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Feb 21, 2011; 17(7): 926-931
Published online Feb 21, 2011. doi: 10.3748/wjg.v17.i7.926
Natural orifice transluminal endoscopic wedge hepatic resection with a water-jet hybrid knife in a non-survival porcine model
Hong Shi, Sheng-Jun Jiang, Bin Li, Deng-Ke Fu, Pei Xin, Yong-Guang Wang
Hong Shi, Bin Li, Pei Xin, Yong-Guang Wang, Institute of Minimally Invasive Medicine, Tongji University, Shanghai 200092, China
Hong Shi, Sheng-Jun Jiang, Bin Li, Deng-Ke Fu, Pei Xin, Yong-Guang Wang, Department of Minimally Invasive Surgery, Beijing Chuiyangliu Hospital, Beijing 100022, China
Author contributions: Shi H, Jiang SJ and Wang YG designed the study; Shi H wrote the first draft of the paper; all the authors contributed to the design and interpretation of the study and to the final manuscript.
Correspondence to: Yong-Guang Wang, MD, PhD, Department of Minimally Invasive Surgery, Beijing Chuiyangliu Hospital, No. 2, Chuiyangliu South Street, Chaoyang District, Beijing 100022, China.
Telephone: +86-10-67718822 Fax: +86-10-67711960
Received: October 6, 2010
Revised: November 17, 2010
Accepted: November 24, 2010
Published online: February 21, 2011

AIM: To explore the feasibility of a water-jet hybrid knife to facilitate wedge hepatic resection using a natural orifice transluminal endoscopic surgery (NOTES) approach in a non-survival porcine model.

METHODS: The Erbe Jet2 water-jet system allows a needleless, tissue-selective hydro-dissection with a pre-selected pressure. Using this system, wedge hepatic resection was performed through three natural routes (trans-anal, trans-vaginal and trans-umbilical) in three female pigs weighing 35 kg under general anesthesia. Entry into the peritoneal cavity was via a 15-mm incision using a hook knife. The targeted liver segment was marked by an APC probe, followed by wedge hepatic resection performed using a water-jet hybrid knife with the aid of a 4-mm transparent distance soft cap mounted onto the tip of the endoscope for holding up the desired plane. The exposed vascular and ductal structures were clipped with Endoclips. Hemostasis was applied to the bleeding cut edges of the liver parenchyma by electrocautery. After the procedure, the incision site was left open, and the animal was euthanized followed by necropsy.

RESULTS: Using the Erbe Jet2 water-jet system, trans-anal and trans-vaginal wedge hepatic resection was successfully performed in two pigs without laparoscopic assistance. Trans-umbilical attempt failed due to an unstable operating platform. The incision for peritoneal entry took 1 min, and about 2 h was spent on excision of the liver tissue. The intra-operative blood loss ranged from 100 to 250 mL. Microscopically, the hydro-dissections were relatively precise and gentle, preserving most vessels.

CONCLUSION: The Erbe Jet2 water-jet system can safely accomplish non-anatomic wedge hepatic resection in NOTES, which deserves further studies to shorten the dissection time.

Keywords: Natural orifice transluminal endoscopic surgery, Hepatic resection, Water-jet, Hybrid knife, Triangulation