A Novel Transvesical Port for Natural Orifice Translumenal Endoscopic Surgery

Purpose: To evaluate the feasibility of a novel transvesical port (TVEP) for natural orifice translumenal endoscopic surgery (NOTES) in the porcine model. Materials and Methods: The TVEP consisted of an internal guide core and external sheath design using computer-aided design software. Transvesical peritoneoscopy, renal biopsy, as well as combined transvesical/transgastric nephrectomy were performed through the TVEP in a porcine model. Operative parameters and port performance were measured. Results: Twelve procedures were successfully performed by four surgeons. No complications occurred with introduction of the TVEP. The mean time for placement was 5.6 minutes. Steady pressure controlled CO2 pneumoperitoneum up to 15 mm Hg with a flow of 2 L/min was achievable. The average scoring by physician of the TVEP was 4.75 for ease of placement, 5 for ability to maintain pneumoperitoneum, 4.25 for convenience of inserting instruments, and 4.5 for overall satisfaction. The average score regarding instruments exchangeability, however, was relatively low: 3.25. Conclusions: Real surgery using a novel TVEP is feasible in performing transvesical NOTES.