Transanal endoscopic microsurgical platform for natural orifice surgery.

摘要

We read with interest the report by Denk et al on the use of a transanal endoscopic microsurgical (TEM) platform for natural orifice surgery. The authors assessed the feasibility of a standard TEM device in 3 porcine and 3 human cadaver models and suggested TEM as a feasible portal for natural orifice transluminal endoscopic surgery (NOTES). We absolutely agree with the authors and share their experience. In our institution, we have been working with a modified TEM device for almost 2 years. So far, we have been using this device successfully for peritoneoscopy, cho-lecystectomy and antireflux procedures in more than 60 pigs, and in a human cadaver study. We would also stress that based on our survival study, the transsigmoid access appears to be safe and leakproof. Avoidance of infectious complications is possible by the additional creation of a hydroperitoneum by instillation of sterile saline and