Feasibility of radical sigmoid colectomy performed as natural orifice translumenal endoscopic surgery (NOTES) using transanal endoscopic microsurgery
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Natural orifice translumenal endoscopic surgery (NOTES), a recent development in the field of minimally invasive surgery, may offer advantages over open and laparoscopic surgery. Most investigations to date have focused on small end-organ resections, and none have described en bloc regional lymphadenectomy. This study aimed to describe a method of anal transcolonic sigmoid colon resection.
A fresh frozen then thawed cadaver model was used. Three male human cadavers were subjected to transanal sigmoid colon mobilization, high vascular ligation, en bloc lymphadenectomy, and stapled end-to-end anastomosis performed by a single operator using transanal endoscopic microsurgery instrumentation.
The findings showed that NOTES sigmoid colon resection with en bloc lymphadenectomy and primary anastomosis can be performed successfully. The critical steps of the procedure were (1) luminal suture occlusion of the sigmoid colon, (2) transrectal bowel division, (3) entry through the mesorectum into the presacral space, (4) en bloc mobilization of the sigmoid colon mesentery off of the retroperitoneum, (5) high ligation of the superior hemorrhoidal artery, (6) transanal delivery of the intact sigmoid colon specimen, (7) extracorporeal division of the colon, and (8) creation of a stapled end-to-end colorectal anastomosis. Postprocedure laparotomy confirmed adequate lymphadenectomy and anastomosis with no untoward events.
It is possible to complete the critical steps of a NOTES sigmoid resection, en bloc lymphadenectomy, primary anastomosis, and retrieval of an intact specimen without any incisions using transanal endoscopic microsurgery instrumentation.
- Jagannath, SB, Kantsevoy, SV, Vaughn, CA, Chung, SS, Cotton, PB, Gostout, CJ, Hawes, RH, Pasricha, PJ, Scorpio, DG, Magee, CA, Pipitone, LJ, Kalloo, AN (2005) Peroral transgastric endoscopic ligation of fallopian tubes with long-term survival in a porcine model. Gastrointest Endosc 61: pp. 449-453 CrossRef
- Park, PO, Bergstrom, M, Ikeda, K, Fritscher-Ravens, A, Swain, P (2005) Experimental studies of transgastric gallbladder surgery: cholecystectomy and cholecystogastric anastomosis (videos). Gastrointest Endosc 61: pp. 601-606 CrossRef
- Rattner Kalloo, D A (2006) ASGE/SAGES Working Group on Natural Orifice Translumenal Endoscopic Surgery. October 2005. Surg Endosc 20: pp. 329-333 CrossRef
- Wagh, MS, Merrifield, BF, Thompson, CC (2006) Survival studies after endoscopic transgastric oophorectomy and tubectomy in a porcine model. Gastrointest Endosc 63: pp. 473-478 CrossRef
- Pai, RD, Fong, DG, Bundga, ME, Odze, RD, Rattner, DW, Thompson, CC (2006) Transcolonic endoscopic cholecystectomy: a NOTES survival study in a porcine model (with video). Gastrointest Endosc 64: pp. 428-434 CrossRef
- Cataldo, PA (2006) Transanal endoscopic microsurgery. Surg Clin North Am 86: pp. 915-925 CrossRef
- Gavagan, JA, Whiteford, MH, Swanstrom, LL (2004) Full-thickness intraperitoneal excision by transanal endoscopic microsurgery does not increase short-term complications. Am J Surg 187: pp. 630-634 CrossRef
- Fleshman, J, Marcello, P, Stamos, MJ, Wexner, SD (2006) Focus Group on Laparoscopic Colectomy Education as endorsed by the American Society of Colon and Rectal Surgeons (ASCRS) and the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES): guidelines for laparoscopic colectomy course. Surg Endosc 20: pp. 1162-1167 CrossRef
- Heald, RJ, Husband, EM, Ryall, RD (1982) The mesorectum in rectal cancer surgery: the clue to pelvic recurrence?. Br J Surg 69: pp. 613-616 CrossRef
- Kantsevoy, SV, Jagannath, SB, Niiyama, H, Chung, SS, Cotton, PB, Gostout, CJ, Hawes, RH, Pasricha, PJ, Magee, CA, Vaughn, CA, Barlow, D, Shimonaka, H, Kalloo, AN (2005) Endoscopic gastrojejunostomy with survival in a porcine model. Gastrointest Endosc 62: pp. 287-292 CrossRef
- Swanstrom, LL, Smiley, P, Zelko, J, Cagle, L (1997) Video endoscopic transanal-rectal tumor excision. Am J Surg 173: pp. 383-385 CrossRef
- Lezoche E, Guerrieri M, Paganini AM, D’Ambrosio G, Baldarelli M, Lezoche G, Feliciotti F, De SA (2005) Transanal endoscopic versus total mesorectal laparoscopic resections of T2-N0 low rectal cancers after neoadjuvant treatment: a prospective randomized trial with a 3-years minimum follow-up period. Surg Endosc 19:751–756
- Feasibility of radical sigmoid colectomy performed as natural orifice translumenal endoscopic surgery (NOTES) using transanal endoscopic microsurgery
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