Usefulness of a Flexible Port for Natural Orifice Transluminal Endoscopic Surgery by the Transrectal and Transvaginal Routes
Figure 4
(a) Flexible port insertion procedure: the flexible port socket of one side is inserted through the surgical opening of 2 to 3 mm in diameter which was created in the rectum. This operation of creating the surgical opening of several millimeters in the rectum is performed under monitoring with the endoscope which was inserted in the abdominal cavity through the gastric wall. The flexible port is inserted into the rectal wall with the traction wire which was attached to the port insertion set through the forceps hole of the gastric camera for monitoring. (b) The flexible port socket of the other side is inserted according to the same procedure as the method in Figure 3(a). Insertion is assisted with the traction wire which is inserted into the abdominal cavity through the forceps hole of the gastric camera for monitoring. (c) The setting of two flexible ports in one set through the operations described in Figures 4(a) and 4(b) is completed. At this moment, make sure to adjust the port length which is required for the abdominal cavity. (d) The photographs of the abdominal cavity monitoring in operations mentioned in Figures 4(a)–4(c): (1) the insertion socket with the loop wire, which is placed to the apex of the flexible port immediately after penetration through the rectal wall. (2) The scene indicates traction with the traction wire which was inserted into the abdominal cavity via the forceps hole of the endoscope through which the socket with the loop wire attached to the apex of the flexible port was guided into the abdominal cavity transgastrically. By this operation, the flexible port is inserted from the rectal wall to the abdominal cavity for a required length and is placed. (e) Photographs ex vivo in Figures 4(a)–4(c). Method of flexible port insertion: the flexible port is inserted one by one. The flexible port socket with the wire loop for traction is pulled toward the mouth with the traction wire which was drawn from the anus via the sheath that had been inserted through the forceps hole of the transgastric endoscope and is guided to the abdominal cavity.
