Perirectal NOTES access: "down-to-up" total mesorectal excision for rectal cancer.

OBJECTIVES: Clinical natural orifice surgery has been applied for abdominal surgery in recent years, mostly by vaginal and oral access. The study describes preliminary successful human applications of transcolonic natural orifice transluminal endoscopic surgery (NOTES), using a new transrectal total mesorectal excision procedure for rectal cancer. METHODS: Institutional review board approval was obtained for the study. In 2 patients with rectal adenocarcinoma, total mesorectal resection and rectosigmoidectomy with lymphadenectomy was performed using a low NOTES transcolonic access. "Down-to-up" mesorectal dissection was achieved either using a flexible scope or a transrectal single port device. The specimens were extracted transanally, and transorificial low anastomosis was performed. RESULTS: Operative time was 350 and 360 minutes, respectively; no complications occurred and patients were discharged after 6 days. CONCLUSION: Successful human reports on transcolonic NOTES suggest potential applications. The treatment of colorectal diseases through transorificial single port or flexible perirectal NOTES access are promising new approaches besides current methods to improve patient care.

Neuro-hormônios do trato gastrintestinal / Neurohormones of the gastrointestinal tract

Os autores fazem um breve estudo acerca da neuroendocrinologia do tubo digestivo. Verificam que diversos hormônios podem potencializar ou inibir açöes fisiológicas agindo sobre um órgäo-alvo comum, situado no trato gastrintestinal. Constatam também a existência de síndromes poliendócrinas capazes de produzir níveis séricos elevados de praticamente todos os peptídeos citados, ampliando-se o conceito e extensäo do sistema APUD. Concluem que o mecanismo etiopatogênico de diversas doenças gastrintestinais näo admite explicaçöes simplistas, ou o emprego de práticas terapêuticas, clínicas ou cirúrgicas tidas como definitivas, pois as anormalidades encontradas na estrutura fisiológica do tubo digestivo estäo relacionadas a distúrbios hormonais complexos e ainda obscuros em vários pontos pesquisados