Second generation sigmoid access for NOTES using the ISSA-system

Background: Transluminal surgery offers challenging possibilities for trauma reduction. Current investigations are mainly focused upon optimization of the access routes and its safe closure. Methods: We developed a trocar system consisting of a modified TEM (transanal endoscopic microsurgery) device and a specially designed overtube, serving as a stable gate for the endoscope during interventions. The TEM device allows for safe, transsigmoid introduction of the overtube into the abdominal cavity and for reliable closure of the entry site by surgical techniques. By the help of a decontaminating solution which is…