| セッション情報 | International Session4(消化器内視鏡学会・消化器病学会合同)Achieving high quality colorectal ESD |
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| タイトル | IS4-基調講演：Endoluminal Procedures beyond ESD |
| 演者 | E. W. Ng（Prince of Wales Hospital） |
| 共同演者 | |
| 抄録 | In the later part of last century, development of laparoscopic technology has revolutionized the entire surgical field by successfully performing a wide variety of operations through miniaturized wound incisions. Such a surgical approach was shown to decrease wound pain, hasten recovery, and improve cosmetic outcomes for the majority of patients. It is also associated with a much lower postoperative morbidity rate and also shorter hospital stay in many procedures. Along the same time line parallel to the emergence of minimally invasive surgical technique, gastrointestinal endoscopy has also evolved tremendously with better designed of accessories and novel instruments. All these rendered complex procedures possible under the flexible endoscope. Typical examples are ERCP, EUS guided therapeutic procedures and also endoscopic submucosal dissection. An even bigger step was lapsed by the attempt of performing transgastric appendectomy in India in the early 2000’s. Since then there is a strong enthusiasm in experimenting natural orifice transluminal endoscopic surgery (NOTES). To address the list of potential obstacles in carrying out NOTES as proposed by the NOSCAR group in 2006, our unit has conducted a series of experiments to hopefully provide answers to some of them. We have evaluated the safety of a single step cannulating needle knife for transgastric establishment of CO2 pneumoperitoneum. We also tested the safety of using the EagleClaw device in closing the gastrotomy after NOTES procedures. A study on intraperitoneal spatial orientation and accessibility has also confirmed that the submucosal tunneling technique is a less preferred way of creating gastrotomy for NOTES procedure. More recently, our unit has attempted two transluminal procedure: per-oral endoscopic myotomy for achalasia and also transgastric gallbladder drainage for acute cholecystitis. The preliminary findings are that these procedures are safe with satisfactory short term clinical outcomes. The future of transluminal procedure is still evolving. Newer platform and devices are very much in need in order to make complex procedures possible. |
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