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OBJECTIVE To present our laboratory experience with natural orifice translumenal endoscopic surgery (NOTES) renal cryoablation. MATERIALS AND METHODS In two female farm pigs, we performed four procedures of NOTES renal cryoablation. In each pig, NOTES was performed through a transgastric approach and a transvaginal approach for each kidney, respectively. The pig was placed in the flank position and pneumoperitoneum obtained using a transabdominal Veress needle. In the first pig, we started with the left kidney with a transgastric approach: a dual-channel video gastroscope (Olympus, Tokyo, Japan) was used, the stomach wall was punctured using a needle-knife, a guidewire was passed into the abdominal cavity and the access dilated using a controlled radial expansion balloon. The bowel was mobilized medially and the Gerota’s fascia overlying the upper pole was dissected. Under direct endoscopic vision, a cryoablation probe was introduced percutaneously into the anterior upper pole of the kidney. The pig was then flipped to the right flank position and a transvaginal approach was used: the gastroscope was introduced through the posterior fornix of the vagina. For the second pig, we performed initially a transgastric right-side cryoablation then a transvaginal left-side cryoablation as described for the first pig. RESULTS All four procedures were performed successfully, with no intraoperative complications. No additional laparoscopic ports or open conversions were necessary. The vision of the kidney and the ice-ball was adequate for all cases. The mean operative duration was 83 min. Stomach closure was tested watertight, and there were no abdominal or pelvic injuries found at autopsy. CONCLUSIONS NOTES can provide adequate minimal surgical dissection for safe and effective percutaneous renal cryoablation under direct videoscopic monitoring at kidney locations otherwise not accessible percutaneously. Both transgastric and transvaginal approaches can be used effectively for renal cryoablation providing a minimally invasive scar-less surgery. [ABSTRACT FROM AUTHOR]

Purpose: To assess the quality of sound and uncompressed images during an international broadcast of live surgery using the newly developed digital video transport system (DVTS)., Methods: Three networks connected hospitals in Seoul, Korea, and Fukuoka, Japan. A teleconference system with bidirectional transmission over the network was set up. DVTS was used to send and receive visual and audio signals during a live broadcast of a laparoscopic partial nephrectomy to viewers at the 94th annual meeting of the Japanese Urological Association. A questionnaire was used to assess the quality of images and sound., Results: Of 713 questionnaires distributed, 418 were collected. The quality of image and voice was ranked very good or good by 95% and 92% of the audience, respectively. The quality of live surgery was considered high by 94% of the audience., Conclusion: Digital video images can be transformed directly to an Internet protocol without compression of the motion images using DVTS. Live surgery via teleconference using DVTS can help surgeons learn the skills of endoscopic surgery.