Hybrid Transvaginal NOTES and Mini-Laparoscopic Colectomy: Benefit Through Synergy

Abstract

Background and Objectives:Hybrid-natural orifice surgery combines the advantages of traditional transabdominal laparoscopic surgery, while limiting surgical trauma to the abdominal wall. Among various routes of intra-abdominal access, the transvaginal method is most appealing because of its utility and proven safety. We describe a series of 4 colonic resections performed with this approach, combined with minilaparoscopy and needlescopic approaches, and discuss the technical aspects, efficacy, and applicability of this technique.Methods:Three patients were selected to undergo hybrid transvaginal natural-orifice right hemicolectomy. A fourth patient, who underwent a segmental resection of a splenic flexure carcinoma, was included. Transvaginal port access was obtained via posterior colpotomy, and was used for dissection, vascular ligation, bowel division, and anastomosis. We used a combination of standard laparoscopic, minilaparoscopic, and needlescopic instruments transabdominally, focusing on reduced size and number of access points.Results:Duration of laparoscopy, oncologic outcomes and rate of operative morbidity were comparable to the published literature. Early return of gastrointestinal function and low analgesic requirements was observed in all patients. No morbidity related to transvaginal access was observed and the procedure was performed without difficulty in all cases.Conclusion:Colonic resection performed by hybrid natural-orifice technique offers several advantages over purely transabdominal laparoscopic procedures. Transvaginal access is easy to perform and offers excellent safety, efficacy, and versatility, especially for right hemicolectomy. Techniques to reduce abdominal wall surgical trauma, such as minilaparoscopy and needlescopic graspers, can be combined effectively in colonic resections, and may act synergistically to reduce postoperative pain and improve outcomes.

Alternative method for the diagnosis of acid cases of unknown cause: Transvaginal natural orifice transluminal endoscopic surgery

“…However, studies performed have not borne out these concerns. 31 No adverse effect associated with infection occurred in our patients during 1 year of follow-up.…”

“…There are concerns about the probability of bacterial transmission and contamination associated with insertion of surgical devices from non sterile cavities to sterile abdominal cavity in transvaginal approach. However, studies performed have not borne out these concerns 31 . No adverse effect associated with infection occurred in our patients during 1 year of follow‐up.…”

Total laparoscopic right hemicolectomy with transvaginal specimen extraction for the treatment of right-sided colon cancer: a local experience

“…Therefore, the transvaginal route is considered to be the ideal choice for specimen retrieval for the laparoscopic colorectal surgery on large and high-situated tumors (such as laparoscopic right hemicolectomy). Literature from various locations worldwide has reported that this procedure was performed to extract the specimen via the transvaginal route during colorectal cancer surgery [16][17][18][19][20] . However, transvaginal NOSES during colorectal cancer surgery has not yet gained widespread clinical applications due to the following limitations: 1) the technique can only be performed in female patients; 2) the vaginal wall incision may increase the risk of associated complications, such as vaginal paresthesia, delivery disorder, dysmenorrhea, and sexual dysfunction; 3) technical di culty in completing the endoscopic bowel anastomosis during the right hemicolectomy; and 4) ethical considerations.…”

“…This indicated that the postoperative sexual life may be improved due to the disappearance of physical discomfort symptoms and the gradual improvement of patients' mood after lesion resection. Several international retrospective studies have also shown that laparoscopic right hemicolectomy with transvaginal specimen extraction had no signi cant effect on the vaginal sensation, ability to achieve orgasm, pregnancy rate, or incidence of dyspareunia [19,20] .…”

Endoscopic trans-esophageal submucosal tunneling surgery: A new therapeutic approach for diseases located around the aorta ventralis

“…Subsequently, a number of scholars used NOTES to simulate a variety of intraperitoneal surgeries including cholecystectomy, colectomy, liver resection, and thyroidectomy in experimental animals[8-11]. A significant and hybrid model of NOTES was proposed for abdominal surgeries using transcutaneous rigid laparoscopes in combination with a flexible endoscope passing through a visceral incision[12,13]. Moreover, it was confirmed that NOTES had been less invasive, safer, and more cost-effective than either traditional or laparoscopic surgery[14].…”