Background: Up to now there are no special? ized flexible endoscopes to perform transluminal
endoscopic surgery.
Aim: To evaluate the capacity of various types of flexible endoscopes in order to reveal
their benefits and disadvantages.
Methods: Since May 2007 up today 25 patients underwent cholecystectomies (23) and liver cysts
fenestrations (2) using flexible endoscopes. Transvaginal (7) and transumbilical approach
(18) were used. All prosedured were peformed by the same surgical team, there were
no conversions, no intra/postoperative complications. In 7/25 cases we used the hybrid
approah with the single access 2/5 mm port introduced at the right subcostal region
to peform gallbladder's tractions and keep up the intra-abdominal pressure. Endoscopic
tools were used, passed through the operating channel of endoscope. To perform the
technique we used single-channel endoscope Olympus GIF-Q160(3), high definition single-channel
endoscope Olympus GIF-Q180H(3), double-channel therapeutic endoscope Olympus GIF-2T160(7),
frontal optics ultrasound-endoscope with curved transducer and channel equipped by
operated elevator Pentax EG-3830UT(2) and Fujinon EG-530U?(6), along with Olympus
R-scope(4).
The single-channel diagnostic endoscopes were the least convenient and caused the
problems with stabilization of the device in abdominal cavity due to their significant
flexibility. Moreover, thin biopsy-channel did not provide fine aspiration of the
contents.
The double-channel therapeutic endoscopes were more stable. Usage of two tools allowed
to perform the limited manipulations in gallbladder neck area; however it did not
enable the basic movement-triangulation and thus limited its application.
The ultrasoud-endoscopes allowed carrying out the intraoperative ultrasonography of
bile ducts. The management of device gave greater opportunities for manipulations
by means of operated elevator.
Usage of R-Scope with two channels allowing the management of tools in two perpendicular
planes was accompanied by best results. The effective technique using two tools provided
for triangulation and tension of tissues, thereby achieving better visualization and
a precision work reducing operative time.
Conclusion: Endoscopic transumbilical and transvaginal surgery using flexible endoscopes is a
feasible, safe and effective technique, offering all advantages of minimally invasive
surgery with excellent cosmetic results. The use of flexible endoscopes has limited
capabilities compared to conventional laparoscopy and SILS. The development of this
technology is closely dependent on the technical evolution.
