Aims: To evaluate the feasibility and safety of a pure natural orifice translumenal endoscopic surgery (NOTES) approach for laparoscopic diaphragmatic repair in a dog model.
Methodology: A 30 mm incision was made in the diaphragm of dogs by needle scalpel to establish the diaphragmatic rupture models after abdominal exploration by transgastric endoscopy. Then, the incision was closed by endoscopic clips. The condition of diaphragmatic healing, abdominal infection, and tissue adhesion were displayed at 4 weeks after operation. Diaphragmatic tissues around the operation site were prepared for pathological examination.
Results: Thirteen diaphragmatic rupture dog models were successfully established. Eleven dogs underwent NOTES and survived for 4 weeks, whereas the other two died during the operation with a success rate of 84.6%. The average operation time was 65 min (range from 35 to 125 min). All survived experimental dogs had well healing in diaphragmatic wounds, but 3 dogs had tissue adhesion between diaphragm and liver or omentum (27.3%, 3 of 11) complicated with fibrous tissue hyperplasia. Besides, one dog had abscess formation.
Conclusions: NOTES approach is technically feasible for laparoscopic diaphragmatic repair in dog models.