AIM: To investigate perception of natural orifice transluminal endoscopic surgery (NOTES) as a potential technique for appendectomy. METHODS: One hundred patients undergoing endoscopy and 100 physicians were given a questionnaire describing in detail the techniques of NOTES and laparoscopic appendectomy. They were asked about the reasons for their preference, choice of orifice, and extent of complication risk they were willing to accept. RESULTS: Fifty patients (50%) and only 21 physicians (21%) preferred NOTES (P < 0.001). Patients had previously heard of NOTES less frequently (7% vs 73%, P < 0.001) and had undergone endoscopy more frequently (88% vs 36%, P < 0.001) than physicians. Absence of hernia was the most common reason for NOTES preference in physicians (80% vs 44%, P = 0.003), whereas reduced pain was the most common reason in patients (66% vs 52%). Physicians were more likely to refuse NOTES as a novel and unsure technique (P < 0.001) and having an increased risk of infection (P < 0.001). The preferred access site in both groups was colon followed by stomach, with vagina being rarely preferred. In multivariable modeling, those with high-school education [odds ratio (OR): 2.68, 95% confidence interval (CI): 1.23-5.83] and prior colonoscopy (OR: 2.10, 95% CI: 1.05-4.19) were more likely to prefer NOTES over laparoscopic appendectomy. There was a steep decline in NOTES preference with increased rate of procedural complications. Male patients were more likely to consent to their wives vaginal NOTES appendectomy than male physicians (P = 0.02). CONCLUSION: The preference of NOTES for appendectomy was greater in patients than physicians and was related to reduced pain and absence of hernia rather than lack of scarring.

• Klíčová slova
• Appendectomy, Laparoscopy, Natural orifice transluminal endoscopic surgery, Patient perception, Physician perception,
• MeSH
• apendektomie metody   MeSH
• dospělí MeSH
• endoskopické operace přirozenými otvory metody   MeSH
• laparoskopie MeSH
• lidé středního věku MeSH
• lidé MeSH
• pacientova volba MeSH
• percepce MeSH
• průzkumy a dotazníky MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

• MeSH
• anestezie MeSH
• endoskopické operace přirozenými otvory metody   MeSH
• fyziologický stres MeSH
• gastrointestinální nemoci chirurgie   MeSH
• lidé MeSH
• pooperační komplikace MeSH
• techniky uzavření rány MeSH
• zvířata MeSH
• Check Tag
• lidé MeSH
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

AIM: To compare natural orifice transluminal endoscopic surgery (NOTES) vs standard laparoscopic ovariectomy in mini pigs with respect to technical aspects, complications and parameters of systemic inflammatory response. METHODS: This was a randomized, experimental, survival study. Ten female mini pigs underwent NOTES transgastric ovariectomy (NOTES group) and ten female mini pigs underwent laparoscopic ovariectomy (LAP group). A "percutaneous endoscopic gastrostomy" approach with guidewire and sphincterotome was used for gastrotomy creation. The ovary was resected using standard biopsy forceps and a snare. The access site was closed using a "KING" closure with a single endoloop and several clips. In the laparoscopic group, a three-port laparoscopy and an ovariectomy were performed with the use of standard laparoscopic devices. C-reactive protein (CRP), white blood count and interleukin (IL)-6 plasma levels were used as indicators of systemic inflammatory response. All animals were euthanized 28 d after surgery. RESULTS: All animals survived without complications. The mean procedure time was 41.3 min ± 17.6 min (NOTES group) and 25.7 min ± 5.25 min (LAP group, P < 0.02). Postmortem examinations demonstrated that 50% and 70% of animals were free of any complications in the NOTES and LAP groups, respectively. The remaining animals developed minor complications (adhesions) in a comparable frequency between the two groups. In the NOTES group, one animal developed a small intramural gastric abscess close to the gastrotomy site. A minor serous exudate that was present in 50% and 40% of the animals in the NOTES and laparoscopy groups, respectively, was not considered a complication. In both groups CRP levels increased significantly on the 2nd and 7th postoperative days (POD) and returned to normal after 28 d. On POD 2, an increase of CRP level was significantly higher in the NOTES group compared to the LAP group. Values of IL-6 did not differ from baseline values in either of the groups postoperatively. Interestingly, the platelet count decreased significantly on POD 2, but returned close to baseline values on POD 7 and PODs 28-30. CONCLUSION: Both NOTES and laparoscopic ovariectomies had a similar frequency of minor complications. However, the NOTES technique produced an increased systemic inflammatory response on POD 2.

• Klíčová slova
• Laparoscopy, Natural orifice transluminal endoscopic surgery, Ovariectomy, Systemic inflammatory response,
• MeSH
• biologické markery krev   MeSH
• C-reaktivní protein metabolismus   MeSH
• časové faktory MeSH
• chirurgické nástroje MeSH
• design vybavení MeSH
• endoskopické operace přirozenými otvory škodlivé účinky   přístrojové vybavení   MeSH
• interleukin-6 krev   MeSH
• laparoskopie škodlivé účinky   přístrojové vybavení   MeSH
• mediátory zánětu krev   MeSH
• miniaturní prasata MeSH
• ovarektomie škodlivé účinky   přístrojové vybavení   metody   MeSH
• počet leukocytů MeSH
• počet trombocytů MeSH
• prasata MeSH
• zánět krev   etiologie   imunologie   MeSH
• zvířata MeSH
• Check Tag
• ženské pohlaví MeSH
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• srovnávací studie MeSH
• Názvy látek
• biologické markery MeSH
• C-reaktivní protein MeSH
• interleukin-6 MeSH
• mediátory zánětu MeSH

INTRODUCTION: The aim of this study was to asses our initial first experience with NOSE techniques in laparoscopic colorectal surgery with both transanal and transvaginal extraction. MATERIAL AND METHODS: In this prospective study, the authors analyzed data from patients in whom NOSE laparoscopic sigmoid, rectosigmoid and rectal resections were performed in the Department of Surgery, University Hospital Ostrava, from May 2011 to October 2011. A group of 7 patients was analyzed based on demographic characteristics (sex,age and BMI). Tumor localization, type of extraction (transanal/transvaginal), the number of removed lymph nodes, tumor size, histology and length of the specimen were also assessed. Furthermore, the following intraoperative data were evaluated: duration of the procedure, frequency of intraoperative complications and conversion rate. During the postoperative period, duration of hospitalization and morbidity rates were evaluated. RESULTS: The patient group included 2 male (28.6%) and 5 female (71.4%) subjects, their median age was 70 years (61-80), BMI 26,76 (24.76-34.67). The pathology was located in the sigmoid colon in 4 cases (57.1%) and in the proximal rectum in 3 cases (42.9%). Transanal extraction was performed in 5 patients (71.4%) and transvaginal extraction in 2 patients (28.6%). The average number of harvested lymph nodes was 13 (10-15), the average lenght of specimen was 16 cm (13-20) and the average tumor size was 4 cm (2-6). Histologically, adenocarcinoma was confirmed in 6 cases (85.7%), and low grade adenoma in 1 case (14.3%). The median duration of surgery was 205 min (140-300) and no intraoperative complications were recorded. No surgical conversion was required. No postoperative complications occured and the median duration of of hospital stay was 7 days (5-11). CONCLUSION: In the selected group of patients, NOSE technique proved to be a safe technique for laparoscopic colorectal procedures, reducing the risk of incisional complications while maintaining the principles of oncological radicality. Therefore, it may be considered a bridge towards NOTES (Natural Orifice Transluminal Endoscopic Surgery), surgery without scars.

• MeSH
• endoskopické operace přirozenými otvory * MeSH
• kolon chirurgie   MeSH
• kolorektální nádory chirurgie   MeSH
• laparoskopie * MeSH
• lidé středního věku MeSH
• lidé MeSH
• rektum chirurgie   MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH

OBJECTIVE: The definition of volvulus is an axial twist of a portion of the gastrointestinal tract along its mesentery. The involved bowel is obstructed partially or completely with a variable degree of arterial and venous occlusion. The colon is the most common site for volvulus. The splenic flexure is the least common site of colonic volvulus. Splenic flexure volvulus (SFV) is a very rare cause of colonic obstruction, constituting 1-2 % of colonic volvulus. Mortality rate of the SFV cases is low. CASE REPORT: We experienced a SFV case who was a 20-year-old male soldier. The case had come to the state hospital with complaints of severe left abdominal and lumbar pain and a medical history of relapsing urinary infection and nephrolithiasis. The doctor had hospitalized him with the diagnosis of paralytic ileus caused by nephrolithiasis. He had died after 14 hours and 35 minutes from hospitalization. Autopsy findings showed out that the death cause was generalized peritonitis due to gangrenous SFV. CONCLUSION: In this paper, we presented this case and discussed its properties in the light of the literature data (Fig. 2, Ref. 7).

• MeSH
• břišní dutina chirurgie   MeSH
• endoskopické operace přirozenými otvory * MeSH
• pooperační komplikace MeSH
• Sus scrofa MeSH
• zvířata MeSH
• Check Tag
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

INTRODUCTION: NOTES--Natural orifice transluminal endoscopic surgery--represents a new surgical approach. The operation is performed via natural openings of the body without causing any damage to the skin and the abdominal wall. At the Department of Surgery of the University Hospital in Pilsen, we have been performing NOTES since 2008. The first animal experiment was performed in that year by a hybrid NOTES technique. METHODS: A prospective study was carried out at the animal experimental room of Charles University in Prague, Faculty of Medicine in Pilsen, on domestic pigs under general anaesthesia. 15 pigs were operated on by the transgastric pure NOTES method using double-channel endoscope. Gastrotomy was performed using a needle knife and the stomach was closed by OTSC clips. The control group consisting of 15 pigs was operated on by classic laparoscopy through a 14-mm port with the use of double-channel endoscope. During the following two weeks the animals underwent clinical monitoring and sonographic examinations, and samples for biochemical and microbiological analysis were collected. Post-mortem examination focusing on infectious complications was performed after 14 days. RESULTS: In comparison with the conventional laparoscopic technique, the transgastric pure NOTES approach has shown similar results. Inflammation in the skin suture appeared in 6 pigs operated on by classic laparascopy. During the clinical and sonography followup as well as in the autopsy of both groups, no signs of focal infection in the abdominal cavity were shown. CONCLUSION: The pure NOTES approach is very difficult, though not unfeasible to put into practice due to our present technical equipment. The development and implementation of the NOTES access into clinical practice would demand better technical equipment.

• MeSH
• endoskopické operace přirozenými otvory * MeSH
• gastrostomie * MeSH
• laparoskopie * MeSH
• Sus scrofa MeSH
• zvířata MeSH
• Check Tag
• zvířata MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH
• srovnávací studie MeSH

INTRODUCTION: NOTES (Natural Orifice Transluminal Endoscopic Surgery) technique was developed to achieve less invasive surgery with the aim to lower frequency of postoperative complications. Cholecystectomy is one of the most frequent elective surgical procedures and is relevant for evaluation of NOTES. The aim of the experimental study was to compare hybrid transrectal and laparoscopic cholecystectomy regarding feasibility and inflammatory response. MATERIAL AND METHODS: A total of 20 pigs weighing 26-56 kg were randomized to laparoscopic or NOTES group. Transrectal approach (15-18 cm from anal edge) was created by needle knife, followed by balloon dilatation and two-channel endoscope was introduced into the abdominal cavity. Cystic artery and duct were clipped and dissected. After extirpation of the gall bladder the colostomy was closed by occlusion loop-and-clip (King' closure) technique. In the laparoscopic group, cholecystectomy was performed by three-port access. Blood samples for evaluation of inflammatory response markers (leukocytes, CRP, interleukin 6) were taken 0, 2nd, 7th and 30th postoperative day, when the experiment ended and pig was euthanized. RESULTS: Two pigs were excluded (1 died early postoperatively for pneumonia, 1 for the rectal closure impossibility after it's laceration during of the gall bladder extirpation). Other pigs survived without complications. Procedure time was significantly longer in NOTES group (134 +/- 27 minutes versus 60 +/- 22 minutes, p < 0.05). White blood cells count and CRP level increased significantly in both groups 2nd and 7th postoperative day and then normalized. Differences between groups were not significant in any of the measured laboratory markers. Sectional finding of exudate and adhesions was comparable in both groups and all transrectal closures were healed. Small subhepatal abscess was found in one pig from NOTES group. CONCLUSION: Transrectal hybrid cholecystectomy is a safe and feasible method with comparable inflammatory responses and longer operating time compared to laparoscopy. A novel loop-and-clip technique was verified as a safe and simple rectal closure.

• MeSH
• cholecystektomie laparoskopická metody   MeSH
• endoskopické operace přirozenými otvory * MeSH
• Sus scrofa MeSH
• zvířata MeSH
• Check Tag
• zvířata MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH

INTRODUCTION: There is evidence that mesenchymal stem cells (MSCs) could trans-differentiate into the liver cells in vitro and in vivo and thus may be used as an unfailing source for stem cell therapy of liver disease. Combination of MSCs (with or without their differentiation in vitro) and minimally invasive procedures as laparoscopy or Natural Orifice Transluminal Endoscopic Surgery (NOTES) represents a chance for many patients waiting for liver transplantation in vain. METHODS: Over 30 millions of autologous MSCs at passage 3 were transplanted via the portal vein in an eight months old miniature pig. The deposition of transplanted cells in liver parenchyma was evaluated histologically and the trans-differential potential of CM-DiI labeled cells was assessed by expression of pig albumin using immunofluorescence. RESULTS: Three weeks after transplantation we detected the labeled cells (solitary, small clusters) in all 10 samples (2 samples from each lobe) but no diffuse distribution in the samples. The localization of CM-DiI+ cells was predominantly observed around the portal triads. We also detected the localization of albumin signal in CM-DiI labeled cells. CONCLUSION: The study results showed that the autologous MSCs (without additional hepatic differentiation in vitro) transplantation through the portal vein led to successful infiltration of intact miniature pig liver parenchyma with detectable in vivo trans-differentiation. NOTES as well as other newly developed surgical approaches in combination with cell therapy seem to be very promising for the treatment of hepatic diseases in near future.

• Klíčová slova
• Natural Orifice Transluminal Endoscopic Surgery, liver cell therapy, mesenchymal stem cells, miniature pig,
• MeSH
• autologní transplantace MeSH
• endoskopické operace přirozenými otvory MeSH
• mezenchymální kmenové buňky * MeSH
• miniaturní prasata MeSH
• prasata MeSH
• transplantace mezenchymálních kmenových buněk * MeSH
• vena portae * MeSH
• zvířata MeSH
• Check Tag
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH

BACKGROUND: Clinical examination, including pre- and postoperative assessment of olfaction function, should be included in evaluating surgical outcomes in patients with pituitary adenomas. Most of the studies are lacking assessment of olfactory function. METHODS: A prospective study of 143 patients who underwent surgical resection of pituitary adenomas from January 2014 to December 2017 was performed. Data on clinical presentation, pre- and postoperative neurologic, endocrinologic, and ophthalmologic examinations, complications, and follow-up outpatient examinations were recorded. Olfactory function was assessed using the Sniffin' Sticks odor identification test preoperatively, postoperatively (3 months), and 1 year after surgery. RESULTS: Normosmia was present preoperatively in 93.7% of patients, postoperatively in 95.8% of patients, and in 95.1% 1 year postsurgery. Hyposmia was present preoperatively in 4.2% of patients, postoperatively in 2.1% of patients, and in 1.4% 1 year after surgery. Anosmia was present preoperatively in 2.1% of patients, postoperatively in 2.1% of patients, and in 3.5% 1 year after surgery. In patients with preoperative normosmia, postoperative hyposmia and anosmia were present in 1.5% of patients. There were no differences according to age, sex, size, or type of pituitary adenoma. CONCLUSIONS: Assessment of olfactory function should be included in the analysis of pituitary adenoma surgery results. This prospective study showed low risk of olfaction deterioration if an endoscopic endonasal approach is used without any mucosal flaps for skull base reconstruction. Further studies that include objective olfaction assessment are warranted.

• Klíčová slova
• Endoscopic endonasal approach, Olfaction, Olfactory function, Pituitary adenoma, Transsphenoidal surgery,
• MeSH
• adenom chirurgie   MeSH
• dospělí MeSH
• endoskopické operace přirozenými otvory škodlivé účinky   metody   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• nádory hypofýzy chirurgie   MeSH
• neuroendoskopie škodlivé účinky   metody   MeSH
• nos MeSH
• pooperační komplikace epidemiologie   etiologie   MeSH
• poruchy čichu epidemiologie   etiologie   MeSH
• prospektivní studie MeSH
• senioři MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

Although uncommon, chronic postfundoplication dysphagia (PFD) is a serious complication of antireflux surgery. Currently, reoperation is the only possible solution as endoscopic pneumatic or hydraulic dilation are not effective. At present, POEM represents a standard method for the treatment of esophageal achalasia; however, in patients with PFD it is an experimental approach whose clinical effectiveness is unknown. Our case report describes a female patient who suffered from severe PFD after two surgeries (fundoplication and subsequent reoperation). Dysphagia and progressive weight loss had developed over the years and all treatment attempts (several sessions of dilation) were unsuccessful. Subsequently, esophageal resection was considered as the last resort. After a discussion in a multidisciplinary team and additional examinations (EndoFLIP), POEM was performed without any complications, and the procedure had an excellent effect without any adverse events.

• Klíčová slova
• POEM, case report, laparoscopic fundoplication, pneumatic dilation, postfundoplication dysphagia,
• MeSH
• achalázie jícnu * chirurgie   MeSH
• endoskopické operace přirozenými otvory * metody   MeSH
• lidé MeSH
• myotomie * škodlivé účinky   metody   MeSH
• poruchy polykání * etiologie   chirurgie   MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH