NOTES及其在泌尿外科的应用.pptVIP

Laparoscopic view of the anterior abdominal wall/peritoneal surface before (A) and after (B) removal of the intracorporeal MAGS cautery device. Note mild blanching of peritoneal surface and the petechiae. Gettman[等人就曾借助多关节针式腹腔镜及软性纤维膀胱镜在实验猪模型上成功地实施了6例经阴道肾切除术 Lima等在动物模型上尝试将经膀胱途径作为内镜下腹腔探查的手术入路 此后，由Lima牵头的该动物实验小组还相继完成了一系列包括肾切除术、胆囊切除术在内的经膀胱与经阴道相结合入路多自然通道结合内镜手术，甚至还尝试了经膀胱内镜下胸腔探查术 Endoscopic view of vesical wall perforation with open-ended ureteral catheter Bladder necropsy. FIG.1.Instrumen tpositioning for nephrectomy by combined transgastric and transvesical approach. a,gastroscope in retro?exion Approaching renal hilus. b,ureteroscope. FIG.2. Gastrotomy creation with papillotomy knife. A,gastroscopic image shows internal view. B,ureteroscopic image shows external view. Upper row left to right: (1) Bladder grasped at center of markings (grasper preloaded with loop). (2) Loop is advanced and specimen withdrawn into loop. (3) Position con?rmed before release of loop. Bottom row left to right: (4) Wire snare loop applied for electrocautery. (5) Specimen regrasped and removed transurethrally. (6) Final specimen contained all 4 markings with a small margin. Upper row, left to right: (1) Gastrotomy made with modi?ed PEG technique and balloon dilation. (2) Endo-scopic loops applied to targeted area of bladder. (3) Sealed specimen and bladder after wire loop electrocautery. Bot-tom row, left to right: (4) Specimen in esophagus. (5) Ex-ternal specimen after transoral removal. (6) Bladder closure reinforced with endoscopic clips. 山东大学齐鲁医院，3只巴马香猪 首先在胃镜下定位胃间质瘤,经胃镜将肿瘤及其周围1cm范围的正常胃壁组织一并切除。 然后胃镜进入腹腔,并于脐下置入2个5mm Trocar及操作器械,在胃镜监视下完成胆囊切除术,将切除的胃间质瘤、胆囊均经胃、食道由口腔取出。 Lima : Third-Generation Nephrectomy Transgastric and Transvesical approach NOTES临床应用 Hybrid Transvaginal Nephrectomy A 23-yr-old woman with right ?ank pain and recurrent urinary tract infection due to a nonfunctional right kidney. She underwent nephrectomy by transvaginal NOTES using the endoscope by vaginal access and two add