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 CO ₂ pneumoperitoneum up to 15mm Hg with a flow of 2L/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.