Journal of Veterinary Clinics (한국임상수의학회지)

The Korean Society of Veterinary Clinics (한국임상수의학회)
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Hybrid Natural Orifice Transluminal Endoscopic Cholecystectomy in Dogs: Transgastric, Transcolonic and Transvaginal Approaches

개에서 자연개구부를 통한 하이브리드 내시경적 담낭절제술: 경위장관, 경결장 및 경질 접근법

  • Kim, Soo-Hyun (College of Veterinary Medicine, Chungnam National University) ;
  • Jeong, Seong-Mok (College of Veterinary Medicine, Chungnam National University) ;
  • Shin, Sa-Kyeng (College of Veterinary Medicine, Chungnam National University) ;
  • Kim, Seong-Su (College of Veterinary Medicine, Chungnam National University) ;
  • Shin, Beom-Jun (College of Veterinary Medicine, Chungnam National University) ;
  • Lee, Jae-Yeon (College of Veterinary Medicine, Chungnam National University) ;
  • Park, Ji-Yeong (College of Veterinary Medicine, Chungnam National University) ;
  • Kim, Myung-Cheol (College of Veterinary Medicine, Chungnam National University) ;
  • Kim, Young-Il (College of Medicine, Chungnam National University) ;
  • Lee, Sang-Il (College of Medicine, Chungnam National University) ;
  • Kim, Ji-Yeon (College of Medicine, Chungnam National University)
  • Accepted : 2011.10.24
  • Published : 2011.10.31
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Abstract

Natural orifice transluminal endoscopic surgery is a newly emerging technique recently, with its many potential advantages in clinical practice. Cholecystectomy by Hybrid NOTES in this work, performed with single working channel endoscope in conjunction with a laparoscopic grasping forceps in dogs, is a "bridge" between laparoscopic procedure and pure NOTES. Three different approaches for cholecystectomy were carried out; transgastric, transcolonic and transvaginal. In all three approaches, abdominal opening was made by a 5 mm trocar, followed by making pneumoperitoneum of 4 mmHg with $CO_2$ insufflator. Transgastric cholecystectomy, single working channel endoscope was advanced to the peritoneal cavity through gastric incision in antral region made by endoscopic needle knife. Endoscope was retroflexed to visualize the gall bladder. Transcolonic access, incision for endoscopic entry was done at right ventral wall of descending colon, 15 cm inside from the anus. Incision in transvaginal access was made at right-ventral region, just caudal to the caudal tubercle. With the simple traction by the laparoscopic grasping forceps, good visualization of surgical field was obtained in all three groups. Cystic duct and artery were ligated with endoclips; for complete gall bladder dissection from liver, L-knife was used. Closure of incision sites were done in transgastric and transcolonic cholecystectomy by endoclips, not in transvaginal approach.

자연개구부를 통한 내시경적 수술 (NOTES)은 최근 많은 잠재적인 장점들로 인해 새롭게 주목받고 있는 수술방법이다. 하지만 국내에서 대부분 사용되어지고 있는 내시경은 기구가 삽입되는 포트가 한 개인 것이 대부분으로 순수 NOTES를 시행하기에는 다소 어려움이 있을 수 있다. 이에 본 실험에서는 복강경과 순수 NOTES의 중간 단계 인 하이브리드 NOTES를 통해 담낭절제술을 실시하였다. 이 방법은 한 개의 복강경 포트를 삽입함으로써 이를 통해 복강경용 겸자를 사용하여 담낭의 견인 역할을 할 수 있다는 장점을 지닌다. 내시경은 경위장관, 경결장 및 경질을 통 해 외부 피부 절개 없이 복강 내로 삽입되어 수술이 진행되었으며 복강 내압은 $CO_2$를 이용하여 4 mmHg로 유지하였다. 위 세 경로를 통한 접근으로 담낭절제술은 모두 성공적으로 이루어졌으며 모든 실험견들은 실험기간동안 임상적인 유의성 없이 좋은 회복을 나타내었다. 본 연구를 통해 개에서 최소 침습적 수술로 담낭절제술을 실시할 수 있는 방법을 확립하고 시술 시에 발생할 수 있는 부작용 등을 확인함으로써 소동물 수의 임상영역에서 최소 침습적 수술이 보급될 수 있는 기초가 되며, 복강경과 내시경의 임상 활용도를 높일 수 있을 것으로 생각된다. 하지만 경결장의 경우 내시경 접근 시 복강 내에서 소수의 세균 감염이 확인되었으며 경결장 접근의 경우 접근 방법에 대한 다른 연구가 필요할 것으로 생각된다.

Keywords

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