Totally laparoscopic resection rectopexy with transanal extraction of the specimen

Rajkumar, J. S.; Raju, Prabhakaran; Akbar, S; Rajkumar, Anirudh; Venkatesan, Gowtham Sundaram; Rajkumar, Shreya

doi:10.4103/ssj.ssj_5_18

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(3 citation statements)

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“…There is abundant data in favour of laparoscopy-assisted performance of these procedures, but the natural orifice specimen extraction technique, leading to more technically demanding anastomotic challenges, has been sparingly reported. An article [8] reported a totally intracorporeal handsewn anastomotic technique compared to an intracorporeal anvil placement similar to ours, but with the anvil pushed head-first into the colonic stump, and the tip secured by purse string suture placement.…”

Section: Resultsmentioning

confidence: 85%

“…Many theories have been put forward regarding the aetiology of rectal prolapse. However, the uniform relationship between rectoanal intussusception and 'dolichosigmoid' with constipation in prolapse patients has been confirmed using defaecography and cineradiographic studies [8,12]. Resection of redundant rectosigmoid becomes mandatory when there is a history of constipation with or without an obvious dolichosigmoid [13].…”

Section: Resultsmentioning

confidence: 99%

“…However, the additional scars on the abdomen used for the hand-port or specimen extraction caused pain and dissatisfaction in some patients, defeating the purpose of a totally laparoscopic approach and adding a risk of herniation at these sites. In recent years, some researchers have reported trans-anal specimen extraction [6][7][8] in malignant and benign rectal pathology. Transrectal-NOSE is a good option for specimen extraction and the creation of an intra-corporeal colorectal anastomosis because of its applicability in both sexes and its frequent indications in left-sided colonic disease [9].…”

Section: Introductionmentioning

confidence: 99%

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Modification of the anastomotic technique in completely laparoscopic resection rectopexy with NOSE — a case report

Mohanty

2022

Kreativnaâ hirurgiâ i onkologiâ

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Introduction. We have come a long way from the era of conventional rectal surgery, with most high-volume centres now practising various degrees of laparoscopy assisted colorectal surgeries, via extracorporeal suturing, ex vivo anastomoses, hand-assisted laparoscopic resection anastomoses to robotic rectal resections. However, the limitation to most such techniques remains the fact that these are not ‘completely’ laparoscopic, with varying degrees of open assistance being required, from mobilization, suturing and anastomoses to specimen extraction via separate abdominal incisions or port-site enlargements. These ‘large’ incisions negate some of the advantages of minimal access surgery and lead to complications at such sites, such as wound breakdown, infections, and incisional herniae. This led to the origin of NOTES (Natural Orifice Translumenal Endoscopic Surgery) and the still fairly new concept of NOSE (Natural Orifice Specimen Extraction).Aim. We aim to describe our application of this new frontier in laparoscopic colorectal surgery, doing away with large scars prone to complications.Materials and methods. We describe a case of completely laparoscopic resection rectopexy and trans-rectal extraction of the specimen, with a modified technique of anvil insertion, enabling the faster creation of a larger anastomosis with probably lower anastomotic morbidity.Results and discussion. The patient underwent a ‘completely’ laparoscopic resection rectopexy and had an uneventful immediate post-operative recovery. She had no delayed post-operative complications or recurrence of the rectal prolapse and remained free of constipation as well, over a follow-up period of 6 months.Conclusion. We conclude that this modification of the surgical technique reduces operative time, allows use of larger circular staplers, theoretically reducing the incidence of anastomotic stricture, and being easily reproducible, can be widely applied for better cosmetic and functional outcome.

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Section: Resultsmentioning

confidence: 85%