Totally laparoscopic sigmoid colectomy: a simple and safe technique for intracorporeal anastomosis

Akamatsu, Hiroki; Omori, Takeshi; Oyama, Tsukasa; Tori, Masayuki; Ueshima, Shigeyuki; Nakahara, Masaaki; Abe, Takashi; Nishida, Toshirou

doi:10.1007/s00464-009-0406-6

Cited by 74 publications

(65 citation statements)

References 9 publications

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“…In our technique, named ‘efficient purse-string stapling technique’, an anvil is placed in the colon through a semi-circumferential colotomy on the colonic wall. Consequently, the colon can be transected using a linear stapling device and placement of the anvil on the colonic stump is completed at the same time [5,6]. Our technique using the stapling device has two advantages over conventional techniques.…”

Section: Discussionmentioning

confidence: 99%

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Totally Laparoscopic Low Anterior Resection for Lower Rectal Cancer: Combination of a New Technique for Intracorporeal Anastomosis with Prolapsing Technique

Akamatsu¹,

Omori²,

Oyama³

et al. 2009

Dig Surg

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Background: Laparoscopically assisted low anterior resection is difficult even for experienced surgeons because of difficulties in selecting the appropriate transection line and completing anastomosis in the narrow pelvic space. The prolapsing technique resolves these problems. We combined our new technique for intracorporeal anastomosis with this prolapsing technique and achieved a totally laparoscopic low anterior resection. Methods: After the total mesorectal excision, a semi-circumferential colotomy is made at the anterior colonic wall just proximal to the proximal transection site. The anvil of a circular stapling device, secured with a Prolene suture, is introduced via the colotomy. The suture is advanced anteriorly so that the center rod of the anvil penetrates the colonic wall. The colon is staple-transected at this point to secure the anvil on the proximal colon. The distal rectum is everted and pulled transanally outside the body using a grasping forceps inserted from the anus. Staple-closure and transection of the distal rectum is performed under direct vision. Anastomosis is established using the double-stapling technique. Results: Totally laparoscopic low anterior resections using this technique were performed for 7 patients with rectal cancer. There was no anastomotic leakage/stenosis. Conclusions: Our procedure can be performed easily, which enables surgeons to achieve minimal invasiveness compared with hybrid NOTES.

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Section: Discussionmentioning

confidence: 99%

“…We have recently reported a simple and safe technique for circular-stapled esophagojejunostomy in laparoscopy-assisted total gastrectomy that eliminates the need for placement of a purse-string suture [5]. We also have reported an application of this technique to totally laparoscopic sigmoid colectomy [6]. …”

Section: Introductionmentioning

confidence: 99%

Totally Laparoscopic Low Anterior Resection for Lower Rectal Cancer: Combination of a New Technique for Intracorporeal Anastomosis with Prolapsing Technique

Akamatsu¹,

Omori²,

Oyama³

et al. 2009

Dig Surg

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“…In addition to the growing international experience with singleport laparoscopic colorectal resection, laparoscopic colorectal resection using transrectal assistance, where tra nsrectal access is used for specimen extraction [26] , insertion of the anvil of a circular stapler for intracorporeal double stapled anastomosis [27,28] , or both [29] has been described. Transvaginal access has also been used as an extraction site following colorectal resection [30] as well part of a hybrid NOTES laparoscopic rectosigmoid dissection [31] where significant portions of the dissection are performed transvaginally.…”

Section: Transcolonic/transanal Notes: Human Experiencementioning

confidence: 99%

NOTES in the management of colorectal diseases: Current experience and future directions

Sylla

2010

WJGS

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Clinical implementation and widespread application of natural orifice translumenal surgery (NOTES) has been limited by the lack of specialized endoscopic equipment, which has prevented the ability to perform complex procedures including colorectal resections. Relative to other types of translumenal access, transanal NOTES using transanal endoscopic microsurgery (TEM) provides a stable platform for endolumenal and direct translu menal access to the peritoneal cavity, and specifically to the colon and rectum. Completely NOTES transanal rectosigmoid resection using TEM, with or without transgastric endoscopic assistance, was demonstrated to be feasible and safe in a swine survival model. The same technique was successfully replicated in human cadavers using commercially available TEM, with end oscopic and laparoscopic instrumentation. This approach also permitted complete rectal mobilization with total mesorectal excision to be performed completely tra nsanally. As in the swine model, transgastric and/or transanal endoscopic assistance extended the length of proximal colon mobilized and overcame some of the difficulties with TEM dissection including limited end oscopic visualization and maladapted instrumentation. This extensive laboratory experience with NOTES tra nsanal rectosigmoid resection served as the basis for the first human NOTES transanal rectal cancer excision using TEM and laparoscopic assistance. Based on this early clinical experience, NOTES transanal approach using TEM holds significant promise as a safe and substantially less morbid alternative to conventional colorectal resection in the management of benign and malignant colorectal diseases. Careful patient selection and substantial impr ovement in NOTES instrumentation are critical to optimize this approach prior to widespread clinical application, and may ultimately permit completely NOTES transanal colorectal resection.

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“…A extração transcolônica ou transvaginal de espécimes em cirurgia laparoscópica tem sido mais utilizada nos últimos anos para permitir extração de baço, rins e cólon, eleiminando a necessidade de incisão auxiliar. Estas técnicas, classificadas como NOSE (natural orifice specimen extraction 38 ) demonstraram bons resultados com poucas complicações relatadas [39][40][41][42][43][44][45] . Colectomia NOTES Transvaginal assistida por minilaparoscopia foi iniccialmente descrita clinicamente por Lacy e cols, denominando a técnica de MA-NOS 46 em uma paciente com câncer de sigmóide.…”

Section: A B C Dunclassified

Cirurgia por orifícios naturais transcolônica: acesso NOTES peri-retal (PNA) para excisão mesoretal total

Zorrón¹,

Coelho

Flach³

et al. 2010

Rev bras. colo-proctol.

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RESUMO: Objetivos: Cirurgia por orifícios naturais tem sido recentemente aplicada em series clínicas para cirurgia abdominal. Apesar de potenciais vantagens do acesso NOTES transcolônico para doenças colorretais, este ainda não havia sido utilizado clinicamente. O presente trabalho descreve a primeira aplicação bem-sucedida de NOTES transcolônico da literatura, em uma nova abordagem de excisão mesoretal total (TME) para cancer de reto. Métodos: Foi obtida aprovação de Comitê de Ética em Pesquisa para cirurgias por orifícios naturais, e o paciente assinou termo de consentimento informado. Em um paciente de 54 anos portador de adenocarcinoma de reto, o procedimento de retossigmoidectomia e linfadenectomia, com excisão mesoretal total foi realizada utilizando um acesso posterior transcolônico pouco acima da borda anal. A dissecção mesorretal foi conseguida utilizando um colonoscópio flexível e instrumentos endoscópicos, com assistência laparoscópica. O espécime foi retirado via transanal, e anastomose foi transorificial, com estoma proximal de proteção. Resultados: O tempo operatório foi de 350 min, não ocorrendo complicações operatórias. A evolução pós-operatória foi favorável, e o paciente recebeu alta no sexto dia de pós-operatório com dieta plena. Conclusão: Este primeiro relato bem sucedido de cirurgia NOTES transcolônica traz potencialmente novas fronteiras de aplicações clínicas na cirurgia minimamente invasiva. O tratamento de doenças colorretais utilizando o novo acesso flexível PNA (Perirectal NOTES Access) é uma promissora nova abordagem, paralelamente à laparoscopia e cirurgia aberta, para melhoria do tratamento dos pacientes.

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Totally laparoscopic sigmoid colectomy: a simple and safe technique for intracorporeal anastomosis

Abstract: The procedure of totally intracorporeal anastomosis combined with transanal extraction of the specimen can be performed easily, enabling surgeons to achieve minimal invasiveness comparable with that of hybrid natural orifice translumenal endoscopic surgery (NOTES).

Cited by 74 publications

References 9 publications

Totally Laparoscopic Low Anterior Resection for Lower Rectal Cancer: Combination of a New Technique for Intracorporeal Anastomosis with Prolapsing Technique

Totally Laparoscopic Low Anterior Resection for Lower Rectal Cancer: Combination of a New Technique for Intracorporeal Anastomosis with Prolapsing Technique

NOTES in the management of colorectal diseases: Current experience and future directions

Cirurgia por orifícios naturais transcolônica: acesso NOTES peri-retal (PNA) para excisão mesoretal total

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