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NOTES might be a way to use regional anesthesia or
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general sedation without taking on the risks of general
surgery and intubation.
Advantages of NOTES over laparoscopy
A major advantage of NOTES over laparoscopy could be
the decreased intraperitoneal pressure needed compared to
laparoscopy [45]. Two technical aspects could allow a
decrease in the abdominal pressure: fi rst, the use of an echoendoscope, which could add the ultrasound information to
the direct vision (to puncture a specifi c organ, for example),
and second, the mobility of the endoscope allows a smaller
“operative fi eld, ” closer to the targeted organ by adapting
the vision in a 360 ° degree manner. A decrease in pressure
could decrease the risk of acidosis [26,46] as well as lower
postoperative infl ammatory response [47,48], postoperative
pain [28, 49] , and adhesion formation [50]. A decrease in
pneumoperitoneum pressure could also improve the management of ventilation [51], a major concern for pregnant
women as the gravid uterus encroaches upon diaphragmatic
excursion [52,53].
One of the biggest advantages to NOTES is that it leaves
free access to the abdominal wall to allow fetal heart monitoring with cardiotocography or Doppler apparatus more
easily than during laparoscopy. The fetal heart could also be
observed using an echoendoscope, which allows direct
vision of the fetal heart [41].
Use of an echoendoscope could allow a safer entry in the
abdominal cavity [54], avoiding uterus injury. Transabdominal ultrasound guidance could be used for transgastric
access, or transvaginal and transillumination could also be
used. During the end of the second and the third trimester
transgastric access is more challenging: depending on the
gestational age, the distance between the gastric wall and
the uterine fundus may vary from a few centimeters to
direct contact (Figure 21.3). Further animal studies in late
pregnancy should be performed to determine the safest
technique for access. Closing the NOTES incision in a safe
manner will also be challenging, but theoretically NOTES
would have less risk of leak during pregnancy, since higher
intra-abdominal pressure can compensate for any increase
in intralumenal pressure.
With NOTES, transabdominal ultrasound also allows evaluation of the posterior vaginal vault, which becomes more
diffi cult laparoscopically with advancing gestational age.
Most of the techniques of the transvaginal access for NOTES
in women have been performed using a classical vaginal
vault incision; however, in one animal study transvaginal
access was obtained using only a puncture and a dilatation
balloon. The transvaginal route also allows a retroperitoneal
approach [55] that could enable the treatment of retroperitoneal pathology in pregnant women and also could extend
to the uterine fundus, thereby avoiding a transperitoneal
entry. Transvaginal access can allow a straight trajectory to
CHAPTER 21 NOTES and Pregnancy
Figure 21.3 MRI showing anatomical connection between the uterus
and the gastric wall during the third trimester. †, Colon; *, Stomach; #,
Fetus.
treat non -gynecologic pathologies (Figure 21.4) such as
appendicitis and cholecystitis, the two most frequent pathologies that require surgery during pregnancy. As with all
transvaginal surgeries in pregnancy, healing of the vaginal
cuff must be complete before delivery or a dehiscence of the
site during labor or delivery could occur.
Obesity
Obesity has become a worldwide concern, with over 30%
of adults estimated to be obese in the United States. This
makes any surgery more challenging, either open or laparoscopic [56]. NOTES has a major potential advantage in the
obese pregnant population because the access remains
unimpeded regardless of the BMI of the patient [57].
Infectious risk
Questions of infectious risk for the fetus and the parturient
during NOTES need to be clarifi ed since pathogens have
been implicated in miscarriage, preterm delivery, and
PPROM [58]. In the study we reported [41], for the non survival animals chemical disinfection was used for the
endoscope and accessories without any other precaution
(such as gastric or oral cavity lavage or parenteral antibiotics). For the survival animal, a high -level disinfection solution 0.55% ortho -phthalaldehyde (Cidex OPA, Ethicon Inc.,
Irvine, CA) and then gas sterilization with ethylene oxide
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SECTION 3 Perspectives on NOTES
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Abdominal wall
Head
Transgastric NOTES
Figure 21.4 Transvaginal and trangastric access during pregnancy.
Uterine wall
Legs
Transvaginal NOTES
Back
were used. For the puncture site (vagina) a broad -spectrum
topical iodophor microbicide (10% povidone -iodine) was
used along with standard sterile surgical technique. In addition, the animal received Intravenous antibiotic (1 g cefazolin). After a period of four weeks, there was no sign of
infection and necropsy did not fi nd damage. In a recent
paper Memark et al. found a contamination of the peritoneal
cavity during transgastric NOTES but this did not lead to an
increased risk of infectious complications [59]. Eickhoff et
al. in a porcine model described a peritoneal bacterial load
to almost zero using intravenous antibiotics, topical antimicrobial lavage of mouth and stomach, and treatment with
proton pump inhibitors [60]. Our team showed that with
sterile technique, no signs of infectious disease were found
compared to 100% of infectious complication when no
sterile conditions were used for transgastric access [61].
Further research has to be performed, particularly in a pregnant model, to better assess the best choice in infection
prophylaxis [62].
Infl ammation and NOTES
Infl ammation and increase in cytokines secretion are one of
the potential mechanisms of preterm delivery [63]. Three
animal studies have reported the assessment of postoperative pro -infl ammatory cytokines comparing NOTES and
laparoscopy with mixed results. All studies were hampered
by design fl aws, including use of different gases and pressures between study groups and controls [64–67]. Further
studies are needed in pregnant models to determine the
nature and effect of the infl ammatory response in NOTES
procedures.
Energy
Another research question to be answered is what energy
to use. Although the ASGE recommends bipolar devices,
there are few such devices in endoscopy practice [68]
and the need for energy (in terms of time and power)
are higher during abdominal surgery compared to endoscopic practice. Bipolar devices are preferred when surgery
is performed near the uterus to avoid the risk of electrical
arc with monopolar cautery and potential consequences to
the fetus.
Devices and instrumentation
During the past fi ve years signifi cant progress has been made
in developing new devices and instrumentation for NOTES
[69]. The operative fi eld is largely reduced by the uterine
volume, but contact with the gravid uterus should still be
minimal to avoid trauma. To that end, new endoscopes,
magnetic anchoring guidance systems, and robots are in
development, and will require thorough evaluation prior to
clinical use. Research will allow major technical improvement but the learning curve for training and skills still needs
to be resolved [70,71]. The pregnant ewe is a good animal
model to deal with the technical issue of NOTES during
surgery as it can develop similar complications such as infection, preterm labor, and preterm delivery. The clinical applicability between this model and human beings in NOTES
has not been fully elucidated. The primate model most
closely resembles the human reproductive system but has
also not been studied in NOTES.
Potential advantages and challenges in developing NOTES
during pregnancy are summarized in Table 21.1. NOTES
could be part of a solution to decrease both maternal and
fetal risk of surgery during pregnancy by potentially providing improvement in risks regarding anesthesia, analgesia,
better access in the obese patient, easier fetal monitoring,
and easier and safer access to the peritoneal cavity. However,
the data in the literature is only in its infancy, leaving many
research opportunities to develop this technique.
236
Table 21.1 Potential advantages and pitfalls to NOTES during pregnancy for maternal pathology.
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Laparoscopy NOTES
Anesthesia General required General, could be regional
Cardiopulmonary parameters Altered Unknown
Thomboembolic events Well known, well managed Unknown
Pain Easily manageable May be less
Increased BMI/obesity More challenging Easier access
Fetal-uterine monitoring Challenging Could be easier
Pneumoperitoneum Pressure 10–12 mmHg Could be lower
Creation Risk of uterine injury Can be visualized at entry
Number of ports 1–3 1
Abdominal scar 1–3 None
Infectious risk Minimal Unknown
Bold, the expected advantages of NOTES versus laparoscopy.
Access to the fetus and to the placenta:
intra-amniotic surgery
Introduction
Intrauterine surgery is, perhaps, the “fi nal frontier ” of
obstetric surgery, and NOTES could potentially play a vital
role. PPROM, preterm labor, and infection continue to be
common complications of open fetal surgery despite extensive animal work using sheep models, and maternal complications are also a major concern. Endoscopic fetal surgery
appears as one solution to decrease the trauma to the fetus
and to the mother [5,72]. In -utero repair of fetal anomalies
holds great promise to mitigate the effects of birth defects.
A recent paper on fetuses with myelomeningocele reported
a reduced need for shunting and improved motor outcomes
in the prenatal surgery group versus postnatal surgery group
[73]. However, open prenatal surgery was associated with
increased maternal and fetal risks; thus, this study is a strong
argument not only for prenatal surgery but also for progress
in fetoscopic surgery. The risks are still substantial: in 2002
Fowler et al. reported morbidity rates of 47% and 49% for
chorioamniotic separation and PPROM, respectively, in 66
cases of twin -twin transfusion syndrome (TTTS) and congenital diaphragmatic hernia after endoscopic surgery [74].
Decreasing risks associated with fetal surgery would mean
lowering invasiveness, easier access to the intrauterine
cavity, shorter operating times, smaller and fewer ports, and
decreased need for pump fl uid exchange [74].
The most common condition leading to intrauterine
surgery is TTTS, where arterial and venous shunts between
twins leads to hydrops and high output cardiac failure in
one twin and growth restriction and decreased perfusion in
the other. Affecting 15 –20% of all monochorionic twin ges-
CHAPTER 21 NOTES and Pregnancy
tations, it has a high mortality rate if left untreated. Surgical
treatment involves coagulation of these anastomoses using
laser. A single 3 mm access is necessary; however, rates of
PPROM remain high (around 20%) [75]. Another condition
treated in utero is diaphragmatic hernia, which involves
placement of a balloon in the fetal trachea to stimulate lung
growth and maturation [76–78].
One major problem of accessing the uterine cavity is the
location of the placenta. An anteriorly located placenta
limits and sometimes blocks access to the uterus, affecting
fetal outcome [79,80]. Similarly, fetal lie can make fetoscopy
impossible. These diffi culties can sometimes be avoided
using a laparoscopically assisted access [80], but that still
requires two or three transabdominal trocars: one for the
laparoscope, one for the fetoscope, and sometimes one for
a blind probe to maintain the uterus and to avoid injury to
intraperitoneal organs [81]. One study compared laparoscope assisted fetoscopy and the percutaneous approach for surgical treatment of TTTS with anterior placentation and found
the neonatal survival rate was better in the laparoscopic assisted group compared to the percutaneous group (80%
versus 59%, respectively; p = 0.045) [80]. Operative time
was longer for laparoscopy, and there was a non -signifi cant
difference in the rate of PPROM and age of delivery.
Another problem during in -utero surgery is closure of the
uterus and avoiding amniotic leak. Several studies have
examined potential strategies to prevent PPROM, including
gelatin sponges, instillation of platelets (amniopatch), microfi brillar collagen, and various combinations of fi brinogen,
thrombin, platelets, and fi brin glue [82,83] but all yielded
suboptimal results. The other issue is the closure of the
myometrium, which is easily performed in open surgery
(absorbable suture) but which is rarely done by minimally
invasive surgery.
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SECTION 3 Perspectives on NOTES
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Visualization in utero presents challenges, as the amniotic
fl uid can be very opaque. One procedure used to improve
visualization is a continuous exchange of amniotic fl uid with
crystalline solutions, but the volume that can be exchanged
via the fetoscope is very little and not suffi cient in the case
of intra -amniotic bleeding. Many authors have proposed the
use of intra -amniotic insuffl ations with CO
nitrous oxide in animal studies [19–25], with limited results
in term of visualization. Further studies are needed to assess
the innocuousness of intra -amniotic insuffl ation.
, air, helium, or
2
NOTES for intra-amniotic surgery during
pregnancy
Review of the literature
Only one study exists in the literature that studied NOTES
and intrauterine surgery [41]. Intraperitoneal access used in
this study was described earlier. For the in utero portion, we
compared traditional abdominal obstetric sonography and
translumenal endoscopic ultrasound (TEUS). TEUS allowed
a reliable and accurate examination of the fetus (Video
21.2). Using a 22 gauge needle, the fetal heart, hepatic
parenchyma, umbilical vessels, and intrahepatic portion of
the inferior vena cava were all successfully accessed. No
immediate complications (bleeding, PPROM, organ damage)
were described during the postoperative 30 minutes of ultrasound observation and at the immediate necropsy for the
two non -survival animals. In the survival animal, four
weeks later no complication (infectious or tissue damage)
was observed during necropsy.
Advantages of NOTES for intrauterine surgery
NOTES could play a major role in advancing intrauterine
surgery in the following ways.
Access to uterine wall
The freedom of the access to the uterine wall should be the
strongest argument to develop NOTES for intra -amniotic
access. While a laparoscope only allows a straight access,
NOTES ensures a 360 ° access with a potential low posterior
access through the vagina. Entry into the uterus could be
easily adapted to the location of the placenta and/or the
fetus (Figure 21.5). The initial puncture point could be
located using the direct endoscopic vision or using echoendoscopy. With the latter, ultrasound is placed in direct
contact with the uterus, not the abdominal wall, with a
potential better assessment of the intrauterine contents. This
would be a particular advantage in the obese patient, as
TEUS would circumvent the abdominal wall barrier.
The pressure of the pneumoperitoneum could be largely
decreased with this direct ultrasound guidance. Entry could
also be perfectly adapted to the orientation of the uterine
wall, allowing a 90 ° angle entrance in all cases. Another
potential benefi t could be the lack of lever effect between
the abdominal wall and uterus that occurs using a rigid
fetoscope. With an endoscope both the entry point (vagina
or gastric wall) and the devices themselves are less rigid.
Similarly, when posterior access to the uterus is required, a
rigid probe is often used to elevate the organ anteriorly; a
fl exible endoscope could navigate posteriorly without substantial manipulation.
Devices and instrumentation
A critical component to the success of NOTES is to reduce
the size of the devices. The trocar sizes used for fetoscopic
surgery are between 2 mm and 6 mm; therefore, the diameter of the endoscope should not exceed this size. Given the
technological progress in the miniaturization of surgical
instrumentation there is strong hope of availability of micro endoscopic surgical devices in the next few years. Multiple
instrument changes contribute to the high rate of fetal membrane injury after fetoscopic surgery (up to 60%) [74,84,85].
With NOTES, the integrated device (camera, suction, instrument) used during NOTES obviates the need to withdraw
the endoscope to change instruments. The major challenge
will also be how to create the entry point: a wire -guided
dilatation balloon could be used but may result in a large
leak of amniotic fl uid in the peritoneal cavity. Specifi c
devices and techniques have to be developed to insure this
way through the uterine wall [86]. The freedom of trans uterine puncture adaptation (angle, location) is an argument for using NOTES because the instrument trajectory
through the uterine wall is not limited by the endoscope ’s
angle through the abdominal wall. For example, in hypoplastic left (or right) heart syndrome some authors propose
in-utero aortic (or pulmonary) valve dilatation. Entry into
the uterus would thus be dependent on fetal lie. NOTES may
be helpful in these cases, because the fetal structures could
be accessed regardless of fetal position [76,85,87].
Closure of the uterus
As opposed to the actual practice during minimally invasive
obstetric surgery (lack of uterine closure in most cases),
techniques and material used during NOTES procedures
could allow the closure of the uterine wall. The adequate
technique has to be determined but many devices are available for gastric closure and should allow a satisfactory closure
of the uterine wall.
Infectious
The rate of postoperative chorioamnionitis following intra amniotic surgery seems to be relatively low (less than 5%)
[88] and occurred more frequently in fetuses that did not
receive antibiotics at the time of the procedure [89]. Even
though an in vitro study demonstrated the antibacterial
properties of human amnion and chorion [90], many vaginal
bacteria have been described as potential causes of preterm
labor, chorioamnionitis, and PPROM. Moreover periodontal
diseases and oral bacteria have been described as possible
238
Abdominal wall
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CHAPTER 21 NOTES and Pregnancy
Left
(a)
Legs
Laparoscopic
angle of access
Placenta
NOTES
potential angle
of access
Back
Abdominal wall
Placenta
Uterine wall
Right
Laparoscopic
angle of access
Uterine wall
Head
NOTES potential
zone of access
(b)
Figure 21.5 Potential angle of access to the uterine cavity: comparison between NOTES and laparoscopic surgery. (a) Transversal view, (b) sagittal view.
causes of preterm labor [91,92]. As we described above,
infectious risk and contamination during NOTES is still
debatable and no one can actually predict the potential
infectious risk for the fetus, and the objective of zero germ
using NOTES seems hard to reach.
As for exclusive maternal surgical pathology, NOTES
could be one part of the solution to decrease both maternal
and fetal risk of surgery during pregnancy. To summarize,
Laparoscopic
zone of access
Back
improvements could include better uterine wall access,
better trajectory for trans -uterine treatment, better intrauterine targeting, reduced need for an intrauterine operative
fi eld using gas or liquid, and enhanced closure of the uterus.
Animal research is also needed to evaluate these potential
advantages of NOTES. Technical improvement, especially
miniaturization, is the most urgently required aspect to
develop NOTES for maternal pathology during pregnancy.
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SECTION 3 Perspectives on NOTES
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Fetal NOTES
Specifi city of “intra-fetal” surgery
The most common pathology that would require intra abdominal access to the fetus is congenital diaphragmatic
hernia (CDH). Open surgery is too invasiveness and has a
very high morbidity despite good anatomical results [76].
Endoscopic surgery using multiple ports offered a new
approach with variable results [93], then a single access was
described [94] with more promising results. Despite the
decrease of invasiveness, results are still controversial [84].
So far, major procedures using open or fetoscopic surgery
have been hampered by high morbidity, and non -invasive
fetal treatments of congenital malformations do not exist.
These limitations open doors to other advanced but minimally invasive treatment [76,85,87].
healing potentially enables fetal NOTES without any closure
of the fetal access. This scarless healing is itself an argument
to perform surgery for congenital anomalies before rather
than after birth [101]. Moreover, a recent paper [103] comparing gastrotomy closure with endoscopically delivered
bioabsorbable plugs with no closure (animal model, 23 dogs)
found no complication in untreated animals, with adequate
healing and fewer adhesions compared to the closure group.
These combinations of data may open a hope of self -mucosal
healing after fetal surgery.
Today, fetal NOTES is just a concept but the alliance
between technological improvement and miniaturization
with the potential in utero healing characteristic may open
the way to this surgery.
Conclusion
Fetal NOTES
Review of the literature
To our knowledge, there are no reports of NOTES performed
in the fetus; however, oral access has been used for fetal
surgery [76]. CDH treatment is attempted by oral access but
other procedures using this access have been reported. Kohl
et al. reported a transesophageal echocardiography during
balloon valvuloplasty [85]. The transesophageal approach
permitted clear visualization of the fetal heart. Another
transabdominal procedure, fetal cystoscopy, has been used
as a diagnostic and treatment tool for severe lower urinary
tract obstruction [95–97]. Trans -urethral ablation of posterior urethral valves could be a fi rst step for fetal NOTES.
However, no intra -abdominal access or intra -thoracic access
in the fetus via NOTES has been described.
Pitfalls and perspectives in the development of
intra-amniotic NOTES
Infectious concern
Since the intrauterine environment itself is sterile, the infectious concern for fetal NOTES will most likely be with regard
to maternal infection.
Access to natural orifi ce, device, and instrumentation
Fetal NOTES will necessitate a huge improvement in material and device miniaturization (from micro -camera to nano device), which may be available in the next decade [98,99].
Closure of the natural orifi ce
In the literature, there are few reports about urinary ascites
or urinoma following trans -uterine placement of vesicoamniotic stents [87,100]. In an animal model of vesicotomy
created by laparoscopy the healing was very fast. An attractive element of fetal NOTES is that fetuses have virtually
scarless healing, which could be attributable to the high level
of growth hormones in amniotic fl uid [101,102]. This
NOTES has the potential to decrease both maternal and fetal
risk of surgery during pregnancy. However, there is little
laboratory and no human experience to date. We explored
potential advantages and challenges to developing NOTES
during pregnancy for maternal, placental, and fetal pathologies. Technical improvement and miniaturization is critical
to develop NOTES for surgery during pregnancy.
Chapter video clips
Video 21.1 NOTES peritoneoscopy demonstrating gravid
uterus. (Courtesy of Samuel Giday.)
Video 21.2 Fetal heart by NOTES (TEUS).
References
1 Kammerer WS. Nonobstetric surgery during pregnancy . Med
Clin North Am 1979;63:1157–64.
2 Kort B, Katz VL, Watson WJ. The effect of nonobstetric opera-
tion during pregnancy . Surg Gynecol Obstet 1993;177:371–6.
3 Schmeler M, Mayo-Smith WW , Peipert JF , et al. Adnexal
masses in pregnancy: surgery compared with observation .
Obstet Gynecol 2005;105:1098–103.
4 Kuczkowski KM. Laparoscopic procedures during pregnancy
and the risks of anesthesia: what does an obstetrician need to
know? Arch Gynecol Obstet 2007;276:201–9.
5 Chescheir NC. Maternal-fetal surgery: where are we and how
did we get here? Obstet Gynecol 2009;113:717–31.
6 Bunyavejchevin S, Phupong V. Laparoscopic surgery for pre-
sumed benign ovarian tumor during pregnancy . Cochrane Data-
base Syst Rev 2006 Oct 18;( 4):CD005459.
7 Sadot E, Telem DA, Arora M, et al. Laparoscopy: a safe approach
to appendicitis during pregnancy . Surg Endosc 2010;24:383–9.
240
CHAPTER 21 NOTES and Pregnancy
https://t.me/med1917
8 McGory ML, Zingmond DS, Tillou A, et al. Negative appendec-
tomy in pregnant women is associated with a substantial risk
of fetal loss . J Am Coll Surg 2007;205:534–40.
9 Azevedo JL, Azevedo OC, Miyahira SA, et al. Injuries caused
by Veress needle insertion for creation of pneumoperitoneum:
a systematic literature review . Surg Endosc 2009;23:1428–32.
10 Kilpatrick CC, Orejuela FJ. Management of the acute abdomen
in pregnancy: a review . Curr Opin Obstet Gynecol 2008;20:
534–9.
11 Wang CJ, Yen CF , Lee CL, Soong YK. Minilaparoscopic cystec-
tomy and appendectomy in late second trimester . JSLS
2002;6:373–5.
12 Phupong V, Bunyavejchewin S. Gasless laparoscopic surgery
for ovarian cyst in a second trimester pregnant patient with a
ventricular septal defect . Surg Laparosc Endosc Percutan Tech
2007;17:565–7.
13 Barwijuk AJ, Paplicki A. [Gasless laparoscopic cyctectomy due
to to ovarian cyst torsion in 14 weeks pregnant patient] .
Ginekol Pol 2005;76:906–9.
14 Oguri H, Taniguchi K, Fukaya T. Gasless laparoscopic manage-
ment of ovarian cysts during pregnancy . Int J Gynaecol Obstet
2005;91:258–9.
15 Melgrati L, Damiani A, Franzoni G, Marziali M, Sesti F. Isobaric
(gasless) laparoscopic myomectomy during pregnancy . J Minim
Invasive Gynecol 2005;12:379–81.
16 Akira S, Yamanaka A, Ishihara T, Takeshita T, Araki T. Gasless
laparoscopic ovarian cystectomy during pregnancy: comparison with laparotomy . Am J Obstet Gynecol 1999;180:554–7.
17 Iafrati MD, Yarnell R, Schwaitzberg SD. Gasless laparoscopic
cholecystectomy in pregnancy . J Laparoendosc Surg 1995;5:
127–30.
18 Vazquez -Rosales MA, Sanchez-Aguilar JM, Hernandez-Sierra
F, et al. Experience with a new design of endoretractor for
gasless laparoscopic cholecystectomy . Surg Laparosc Endosc Per-
cutan Tech 2010;20:416–19.
19 Pelletier GJ, Srinathan SK, Langer JC. Effects of intraamniotic
helium, carbon dioxide, and water on fetal lambs . J Pediatr Surg
1995;30:1155–8.
20 Luks FI, Deprest J, Marcus M, et al. Carbon dioxide pneu-
moamnios causes acidosis in fetal lamb . Fetal Diagn Ther
1994;9:105–9.
21 Till H, Yeung CK, Bower W, et al. Fetoscopy under gas amnio-
distension: pressure -dependent infl uence of helium vs nitrous
oxide on fetal goats . J Pediatr Surg 2007;42:1255–8.
22 Gratacos E, Wu J, Devlieger R, Van de Velde M, Deprest JA.
Effects of amniodistention with carbon dioxide on fetal acid base status during fetoscopic surgery in a sheep model . Surg
Endosc 2001;15:368–72.
23 Gratacos E, Wu J, Devlieger R, et al. Nitrous oxide amniodis-
tention compared with fl uid amniodistention reduces operation time while inducing no changes in fetal acid -base status
in a sheep model for endoscopic fetal surgery . Am J Obstet
Gynecol 2002;186:538–43.
24 Kohl T, Ziemann M, Weinbach J, et al. Partial amniotic carbon
dioxide insuffl ation during minimally invasive fetoscopic interventions seems safe for the fetal brain in sheep . J Laparoendosc
Adv Surg Tech A 2010;20:651–3.
25 Kohl T, Reckers J, Strumper D, et al. Amniotic air insuffl ation
during minimally invasive fetoscopic fetal cardiac interventions
is safe for the fetal brain in sheep . J Thorac Cardiovasc Surg
2004;128:467–71.
26 Bourdel N, Matsuzaki S, Bazin JE, et al. Peritoneal tissue -
oxygen tension during a carbon dioxide pneumoperitoneum
in a mouse laparoscopic model with controlled respiratory
support. Hum Reprod 2007;22:1149–55.
27 Krause P, Bobisch NS, Thelen P, et al. The plasminogen activa-
tor inhibitor system in colon cancer cell lines is infl uenced by
the CO 2 pneumoperitoneum . Int J Colorectal Dis 2011;26:
37–43.
28 Joshipura VP , Haribhakti SP , Patel NR, et al. A prospective
randomized, controlled study comparing low pressure versus
high pressure pneumoperitoneum during laparoscopic cholecystectomy . Surg Laparosc Endosc Percutan Tech 2009;19:
234–40.
29 Naughton N, Cohen S. Nonobstetric surgery during pregnancy .
In Obstetric Anesthesia: Principles and Practice, DH Chestnut (Ed.),
Philadelphia: Elsevier Mosby , 2004, pp. 255–72.
30 Cheek TG, Baird E. Anesthesia for nonobstetric surgery: mater-
nal and fetal considerations . Clin Obstet Gynecol 2009;52:
535–45.
31 Nguyen NT , Hinojosa MW , Fayad C, et al. Laparoscopic surgery
is associated with a lower incidence of venous thromboembolism compared with open surgery . Ann Surg 2007;246:
1021–7.
32 Bruno JM, Kroser J. Effi cacy and safety of upper endoscopy
procedures during pregnancy . Gastrointest Endosc Clin N Am
2006;16:33–40.
33 Qureshi WA , Rajan E, Adler DG,et al. ASGE Guideline: Guide-
lines for endoscopy in pregnant and lactating women . Gastroin-
test Endosc 2005;61:357–62.
34 Cappell MS, Fox SR, Gorrepati N. Safety and effi cacy of colon-
oscopy during pregnancy: an analysis of pregnancy outcome
in 20 patients . J Reprod Med 2010;55:115–23.
35 Senadhi V, Chaudhary J, Dutta S. Percutaneous endoscopic
gastrostomy placement during pregnancy in the critical care
setting. Endoscopy 2010;42(suppl 2 ):E358–9.
36 Schrag SP , Sharma R, Jaik NP , et al. Complications related to
percutaneous endoscopic gastrostomy (PEG) tubes. A comprehensive clinical review . J Gastrointestin Liver Dis 2007;16:
407–18.
37 Irving PM, Howell RJ, Shidrawi RG. Percutaneous
endoscopic gastrostomy with a jejunal port for severe
hyperemesis gravidarum . Eur J Gastroenterol Hepatol 2004;16:
937–9.
38 Ryan ME. Endoscopic management of a pancreatic pseudocyst
during pregnancy . Gastrointest Endosc 1992;38:605–8.
39 Eddy JJ, Lynch GE, Treacy DE. Pancreatic pseudocysts in preg-
nancy: a case report and review of the literature . J Perinatol
2003;23:69–72.
40 Gyokeres T. Successful endoscopic resolution of pancreatic
pseudocyst in pregnancy . J Perinatol 2004;24:270.
41 Giday SA, Buscaglia JM, Althaus J, et al. Successful diagnostic
and therapeutic intrauterine fetal interventions by natural
orifi ce transluminal endoscopic surgery (with videos) . Gastroin-
test Endosc 2009;70:377–81.
42 Cohen-Kerem R, Railton C, Oren D, Lishner M, Koren G.
Pregnancy outcome following non -obstetric surgical intervention. Am J Surg 2005;190:467–73.
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43 Gorsuch RL, Key MK. Abnormalities of pregnancy as a function
of anxiety and life stress . Psychosom Med 1974;36:352–62.
44 Freeman LJ, Rahmani EY , Al-Haddad M, et al. Comparison of
pain and postoperative stress in dogs undergoing natural orifi ce
transluminal endoscopic surgery, laparoscopic, and open
oophorectomy . Gastrointest Endosc 2010;72:373–80.
45 Moran EA, Gostout CJ, McConico AL, Bingener J. Natural
orifi ce translumenal endoscopic surgery used for perforated
viscus repair is feasible using lower peritoneal pressures than
laparoscopy in a porcine model . J Am Coll Surg 2010;210:
474–9.
46 Ibraheim OA, Samarkandi AH, Alshehry H, Faden A, Farouk
EO. Lactate and acid base changes during laparoscopic cholecystectomy . Middle East J Anesthesiol 2006;18:757–68.
47 de Souza AM, Wang CC, Chu CY , Lam PM, Rogers MS. The
effect of intra -abdominal pressure on the generation of 8 -iso
prostaglandin F2alpha during laparoscopy in rabbits . Hum
Reprod 2003;18:2181–8.
48 Bourdel N, Matsuzaki S, Bazin JE, et al. Postoperative perito-
neal dissemination of ovarian cancer cells is not promoted by
carbon-dioxide pneumoperitoneum at low intraperitoneal
pressure in a syngenic mouse laparoscopic model with controlled respiratory support: a pilot study . J Minim Invasive Gynecol
2008;15:321–6.
49 Sarli L, Costi R, Sansebastiano G, Trivelli M, Roncoroni L. Pro-
spective randomized trial of low -pressure pneumoperitoneum
for reduction of shoulder -tip pain following laparoscopy . Br J
Surg 2000;87:1161–5.
50 Molinas CR, Mynbaev O, Pauwels A, Novak P, Koninckx PR.
Peritoneal mesothelial hypoxia during pneumoperitoneum is
a cofactor in adhesion formation in a laparoscopic mouse
model. Fertil Steril 2001;76:560–7.
51 Valenza F, Chevallard G, Fossali T, et al. Management of
mechanical ventilation during laparoscopic surgery . Best Pract
Res Clin Anaesthesiol 2010;24:227–41.
52 Hering R, Hoeft A, Putensen C, et al. Maternal haemodynamics
and lung water content during percutaneous fetoscopic interventions under general anaesthesia . Br J Anaesth 2009;102:
523–7.
53 Robinson MB, Crombleholme TM, Kurth CD. Maternal pulmo-
nary edema during fetoscopic surgery . Anesth Analg 2008;107:
1978–80.
54 Elmunzer BJ, Schomisch SJ, Trunzo JA, et al. EUS in localizing
safe alternate access sites for natural orifi ce transluminal endoscopic surgery: initial experience in a porcine model . Gastroin-
test Endosc 2009;69:108–14.
55 Bourdel N, Kondo W, Botchorishvili R, et al. Assessment of
sentinel nodes for gynecologic malignancies by natural orifi ces
transluminal endoscopic surgery (NOTES): preliminary report .
Gynecol Oncol 2009;115:367–70.
56 Chohan L, Kilpatrick CC. Laparoscopy in pregnancy: a litera-
ture review . Clin Obstet Gynecol 2009;52:557–69.
57 Chouillard EK, Al Khoury M, Bader G, et al. Combined vaginal
and abdominal approach to sleeve gastrectomy for morbid
obesity in women: a preliminary experience . Surg Obes Relat Dis
2011;7(5):581–6.
58 Genc MR, Onderdonk A. Endogenous bacterial fl ora in preg-
nant women and the infl uence of maternal genetic variation .
BJOG 2011;118:154–63.
59 Memark VC, Anderson JB, Nau PN, et al. Transgastric endo-
scopic peritoneoscopy does not lead to increased risk of infectious complications . Surg Endosc 2011;25(7):2186–91.
60 Eickhoff A, Vetter S, von Renteln D, et al. Effectivity of current
sterility methods for transgastric NOTES procedures: results of
a randomized porcine study . Endoscopy 2010;42:748–52.
61 Giday SA, Dray X, Magno P, et al. Infection during natural
orifi ce transluminal endoscopic surgery: a randomized, controlled study in a live porcine model . Gastrointest Endosc
2010;71:812–16.
62 Fritscher -Ravens A, Arlt A. Safety notes: how to avoid infec-
tions in natural orifi ce transluminal endoscopic surgery . Endos-
copy 2011;43:58–62.
63 Menon R. Spontaneous preterm birth, a clinical dilemma: etio-
logic, pathophysiologic and genetic heterogeneities and racial
disparity . Acta Obstet Gynecol Scand 2008;87:590–600.
64 Bingener J, Krishnegowda NK, Michalek JE. Immunologic
parameters during NOTES compared with laparoscopy in a
randomized blinded porcine trial . Surg Endosc 2009;23:
178–81.
65 Basgul E, Bahadir B, Celiker V, et al. Effects of low and high
intra-abdominal pressure on immune response in laparoscopic
cholecystectomy . Saudi Med J 2004;25:1888–91.
66 McGee MF , Schomisch SJ, Marks JM, et al. Late phase TNF -
alpha depression in natural orifi ce translumenal endoscopic
surgery (NOTES) peritoneoscopy . Surgery 2008;143:318–28.
67 Trunzo JA, McGee MF , Cavazzola LT , et al. Peritoneal infl am-
matory response of natural orifi ce translumenal endoscopic
surgery (NOTES) versus laparoscopy with carbon dioxide and
air pneumoperitoneum . Surg Endosc 2010;24:1727–36.
68 Park PO, Long GL, Bergstrom M, et al. A randomized compari-
son of a new fl exible bipolar hemostasis forceps designed principally for NOTES versus a conventional surgical laparoscopic
bipolar forceps for intra -abdominal vessel sealing in a porcine
model. Gastrointest Endosc 2010;71:835–41.
69 Granberg CF , Gettman MT . Instrumentation for natural orifi ce
translumenal endoscopic surgery and laparoendoscopic single site surgery . Indian J Urol 2010;26:385–8.
70 Tiwari MM, Reynoso JF , Lehman AC, et al. In vivo miniature
robots for natural orifi ce surgery: state of the art and future
perspectives. World J Gastrointest Surg 2010;2:217–23.
71 Best SL, Kabbani W, Scott DJ, et al. Magnetic anchoring and
guidance system instrumentation for laparo -endoscopic single site surgery/natural orifi ce transluminal endoscopic surgery:
lack of histologic damage after prolonged magnetic coupling
across the abdominal wall . Urology 2011;77:243–7.
72 Luks FI, Carr SR, Muratore CS, O’Brien BM, Tracy TF .
The pediatric surgeons ’ contribution to in utero treatment of
twin-to-twin transfusion syndrome . Ann Surg 2009;250:
456–62.
73 Adzick NS, Thom EA, Spong CY , et al. A randomized trial of
prenatal versus postnatal repair of myelomeningocele . N Engl
J Med 2011; 364(11):993–1004.
74 Fowler SF , Sydorak RM, Albanese CT , et al. Fetal endoscopic
surgery: lessons learned and trends reviewed . J Pediatr Surg
2002;37:1700–702.
75 Robyr R, Lewi L, Salomon LJ, et al. Prevalence and manage-
ment of late fetal complications following successful selective
laser coagulation of chorionic plate anastomoses in twin -to-
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twin transfusion syndrome . Am J Obstet Gynecol 2006;194:
796–803.
76 Luks FI. New and/or improved aspects of fetal surgery . Prenat
Diagn 2011;31(3):252–8.
77 Deprest J, Gratacos E, Nicolaides KH. Fetoscopic tracheal occlu-
sion (FETO) for severe congenital diaphragmatic hernia: evolution of a technique and preliminary results . Ultrasound Obstet
Gynecol 2004;24:121–6.
78 Kohl T, Gembruch U, Filsinger B, et al. Encouraging early clini-
cal experience with deliberately delayed temporary fetoscopic
tracheal occlusion for the prenatal treatment of life -threatening
right and left congenital diaphragmatic hernias . Fetal Diagn Ther
2006;21:314–18.
79 Deprest JA, Lerut TE, Vandenberghe K. Operative fetoscopy:
new perspective in fetal therapy? Prenat Diagn 1997;17:
1247–60.
80 Papanna R, Johnson A, Ivey RT , et al. Laparoscopy-assisted
fetoscopy for laser surgery in twin -twin transfusion syndrome
with anterior placentation . Ultrasound Obstet Gynecol 2010;35:
65–70.
81 Middeldorp JM, Lopriore E, Sueters M, et al. Laparoscopically
guided uterine entry for fetoscopy in twin -to-twin transfusion
syndrome with completely anterior placenta: a novel technique. Fetal Diagn Ther 2007;22:409–15.
82 Luks FI, Deprest JA, Peers KH, Steegers EA, van Der Wildt B.
Gelatin sponge plug to seal fetoscopy port sites: technique in
ovine and primate models . Am J Obstet Gynecol 1999;181:
995–6.
83 Chang J, Tracy TF ,Jr , Carr SR, Sorrells DL, Jr , Luks FI. Port
insertion and removal techniques to minimize premature
rupture of the membranes in endoscopic fetal surgery . J Pediatr
Surg 2006;41:905–9.
84 Harrison MR, Keller RL, Hawgood SB, et al. A randomized trial
of fetal endoscopic tracheal occlusion for severe fetal congenital
diaphragmatic hernia . N Engl J Med 2003;349:1916–24.
85 Kohl T, Hering R, Van de Vondel P, et al. Analysis of the step-
wise clinical introduction of experimental percutaneous fetoscopic surgical techniques for upcoming minimally invasive
fetal cardiac interventions . Surg Endosc 2006;20:1134–43.
86 Quintero RA, Huhta J, Suh E, et al. In utero cardiac fetal
surgery: laser atrial septotomy in the treatment of hypoplastic
left heart syndrome with intact atrial septum . Am J Obstet
Gynecol 2005;193:1424–8.
87 Springer A, Fartacek R, Reck CA, Horcher E, Bettelheim D.
Major complication after intrauterine vesico -amniotic shunting. Afr J Paediatr Surg 2010;7:200–202.
88 Kohl T, Sharland G, Allan LD, et al. World experience of per-
cutaneous ultrasound -guided balloon valvuloplasty in human
fetuses with severe aortic valve obstruction . Am J Cardiol
2000;85:1230–33.
89 Freedman AL, Johnson MP , Gonzalez R. F etal therapy for
obstructive uropathy: past, present, future? Pediatr Nephrol
2000;14:167–76.
90 Kjaergaard N, Hein M, Hyttel L, et al. Antibacterial properties
of human amnion and chorion in vitro . Eur J Obstet Gynecol
Reprod Biol, 2001;94:224–9.
91 Srinivasan U, Misra D, Marazita ML, Foxman B. Vaginal and
oral microbes, host genotype and preterm birth . Med Hypotheses
2009;73:963–75.
92 Sacco G, Carmagnola D, Abati S, et al. Periodontal disease and
preterm birth relationship: a review of the literature . Minerva
Stomatol 2008;57:233–46, 246–50.
93 VanderWall KJ, Bruch SW , Meuli M, et al. Fetal endoscopic
(“Fetendo”) tracheal clip . J Pediatr Surg 1996;31:1101–3; discussion 1103–4.
94 Deprest JA, Evrard VA , Van Ballaer PP , et al. Tracheoscopic
endoluminal plugging using an infl atable device in the fetal
lamb model . Eur J Obstet Gynecol Reprod Biol 1998;81:165–9.
95 Quintero RA, Hume R, Smith C, et al. Percutaneous fetal cys-
toscopy and endoscopic fulguration of posterior urethral
valves. Am J Obstet Gynecol 1995;172:206–9.
96 Quintero RA, Johnson MP , Romero R, et al. In-utero percuta-
neous cystoscopy in the management of fetal lower obstructive
uropathy . Lancet 1995;346:537–40.
97 Ruano R, Duarte S, Bunduki V, et al. Fetal cystoscopy for severe
lower urinary tract obstruction – initial experience of a single
center . Prenat Diagn 2010;30:30–39.
98 Tanaka A, Saito S. Percutaneous coronary intervention with a
virtual 2 -Fr system . Catheter Cardiovasc Interv 2010;76:684–6.
99 Balicki M, Uneri A, Iordachita I, et al. Micro-force sensing
in robot assisted membrane peeling for vitreoretinal
surgery . Med Image Comput Comput Assist Interv 2010;13(pt 3 ):
303–10.
100 Lunacek A, Oswald J, Schwentner C, et al. Prenatal puncture
of a unilateral hydronephrosis leading to fetal urinoma and
postnatal nephrectomy . Urology 2004;63:982–4.
101 Lambretti S. Fetal surgery . Radiol Technol 2009;81:194–8.
102 Adzick NS, Harrison MR. Fetal surgical therapy . Lancet
1994;343:897–902.
103 Bergman S, Fix DJ, Volt K, et al. Do gastrotomies require repair
after endoscopic transgastric peritoneoscopy? A controlled
study . Gastrointest Endosc 2010;71:1013–17.
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Thoracic Cavity Application of NOTES
Alex Escalona,1Brian G. Turner ,2& Denise W. Gee
1
Pontifi cia Universidad Cat ólica de Chile, Santiago, Chile
2
Weil Cornell Medical College, New York, NY, USA
3
Massachusetts General Hospital, Boston, MA, USA
Introduction
Since the introduction of laparoscopic cholecystectomy,
minimally invasive surgical techniques have become the
standard approach in various areas of surgical practice. In
the fi eld of thoracic surgery, video -assisted thoracoscopic
surgery (VATS) and video -assisted mediastinoscopy (VAM)
were developed as minimally invasive alternatives to open
surgery. VATS, initially introduced as a diagnostic tool for
pleural biopsies, wedge resections, blebectomies, and lung
biopsies, has evolved as an alternative treatment in malignant conditions such as lung cancer [1]. Compared to conventional mediastinoscopy, VAM has shown similar results
in terms of safety and effi cacy [2]. Overall, these thoracic
techniques have been associated with shorter hospital stay,
less pain, and fewer postoperative complications, especially
in high -volume centers, and are now a standard of care for
many thoracic diseases [3].
Over the past decade, natural orifi ce translumenal endoscopic surgery (NOTES) has emerged as a novel, potentially
less invasive, alternative to laparoscopic surgery [4]. Indeed,
after numerous animal studies and increasing reports of successful human experiences, this new fi eld has gained interest and attention among surgeons, gastroenterologists, and
industry alike [5]. Thoracic NOTES has not been an exception and many groups have dedicated their time to the study
and development of this new area of research. However,
contrary to the rapid development of laparoscopic surgery a
decade before, the complexity of NOTES and the necessity
for new technology have resulted in a slower transition to
human studies, especially in thoracic surgery. This is one of
the main reasons why the majority of thoracic NOTES
research has been based on animal models.
3
The purpose of this chapter is to review the thoracic cavity
application of NOTES based on the current available data in
animal and human studies, to evaluate different approaches
and techniques, and to discuss the future work needed to
advance into human trials.
Access to the thoracic cavity
The concept of NOTES implies the use of a natural orifi ce to
access the human body cavities. In the case of the thorax
and mediastinum, the mouth is perhaps the most natural
and feasible access route, making the transesophageal
approach the most commonly used technique and the major
focus of this chapter. Other access routes, however, have
also been described and merit discussion. These include
transtracheal and transdiaphragmatic approaches. Yang et
al. described the feasibility of transtracheal access for endoscopic evaluation of the mediastinum and thoracic cavity
[6]. The procedure was performed in two canines. One
required chest tube drainage to manage postoperative subcutaneous emphysema. Both animals survived for two
weeks with good healing of the tracheal wounds. Another
series described the feasibility of a pericardial window in 14
canines using the same transtracheal approach [7]. Based on
their previous experience, the authors used intraoperative
pleural drainage to decrease the rate of pneumothorax as
well as a stent to cover the tracheal incision [8,9]. Peri operative mortality was reported in 3 of 14 animals. The
remaining 11 animals survived without complications for 2
weeks. Liu et al. described the same approach to perform
pleural biopsy, lung biopsy, and pericardial window in six
pigs and six dogs [7]. Four animals died peri -operatively
secondary to tension pneumothorax in two pigs and one dog
Natural Orifi ce Translumenal Endoscopic Surgery (NOTES): Textbook and Video Atlas, First Edition. Edited by Anthony N. Kalloo, Jacques Marescaux,
Ricardo Zorron.
© 2012 John Wiley & Sons, Ltd. Published 2012 by John Wiley & Sons, Ltd.
244
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