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Diagnostic and Therapeutic Endoscopy
Volume 2010 (2010), Article ID 473080, 12 pages
Research Article

Usefulness of a Flexible Port for Natural Orifice Transluminal Endoscopic Surgery by the Transrectal and Transvaginal Routes

1Department of Advanced Medicine and Innovative Technology, Kyshu University Hospital, 3-1-1, Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
2Department of Endoscopy, The Jikei University School of Medicine, Tokyo, Japan
3Division of Gastroenterology and Hepatology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
4Department of General Surgery, The Jichi Medical University, Tochigi, Japan

Received 7 November 2009; Revised 16 March 2010; Accepted 23 March 2010

Academic Editor: Pedro F. Escobar

Copyright © 2010 Takeshi Ohdaira et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


We developed a flexible port for NOTES which allows the use of conventional forceps for laparoscope-assisted surgery without change. The port is not affected by the location of the through hole in the gastrointestinal tract or vagina which elicits a problem in conventional NOTES, and its length can be adjusted during surgery by cutting the port itself. The port is made of polymer resin with a low friction coefficient. Furthermore, the port walls have a square wave structure which contributes to (1) the prevention of devices, for example, endoscope, from getting stuck at the time of insertion and retrieval, (2) the prevention of port slippage in the surgical opening for port insertion, (3) the prevention of unexpected port removal, (4) the prevention of port bore deformation, and (5) the improvement of port flexibility in the longitudinal direction. We validated the insertion and retrieval capacities of commercially available forceps for laparoscope-assisted surgery and power devices. Furthermore, we used the flexible port to conduct cholecystectomy and partial gastrectomy. We could confirm that the selection of the flexible port diameter according to the device type allowed the smooth insertion and retrieval of the device and that the port produced no air leakage. We affirmed that it is possible to conduct surgery by the cross or parallel method similarly to single port surgery. We considered that the flexible port has a potential of becoming a revolutionary port in NOTES.