Robotic natural orifice specimen extraction (NOSE) total colectomy with ileorectal anastomosis: a step-by-step video-guided technical note

  • T.-C. Chen
  • J.-T. LiangEmail author
Technical Note


Total colectomy with ileorectal anastomosis (TC-IRA) is indicated for familial adenomatous polyposis (FAP) and colonic inertia (CI). FAP is an inherited autosomal dominant disease, and the affected individuals inevitably develop cancer at a relatively young age if this condition remains untreated. However, in consideration of retaining anorectal function for young patients with FAP, TC-IRA may be the first choice, although total proctocolectomy with ileal pouch-anal anastomosis may be eventually inevitable for such patients to prevent colorectal cancer [1]. CI, also known as slow-transit constipation, is a colorectal motility disorder, in which severe constipation cannot be effectively treated by conservative treatment and total colectomy is frequently required. Most reported series have shown that TC-IRA can significantly improve the quality of life for such patients [2, 3]. However, TC-IRA is a complex procedure, and postoperative complications are a major issue [4, 5],...



This study was supported by the National Taiwan University Hospital (grant number: 108-18, Dr. Tzu-Chun Chen).

Author contributions

T-CC, the first author, was responsible for the writing, data collection, and video editing of this article; J-TL, the second and corresponding author, supplied the patients and supervised the writing of this article.


This study was funded by a research project of the National Taiwan University Hospital (grant number 108-18).

Compliance with ethical standards

Conflicts of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional review board of National Taiwan University Hospital (protocol no. 201804001RINA) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Supplementary material

Supplementary material 1 (MP4 91371 kb)

Supplementary material 2 (MP4 159566 kb)

Supplementary material 3 (MP4 89744 kb)


  1. 1.
    Konishi T, Ishida H, Ueno H, Kobayashi H, Hinoi T, Inoue Y et al (2016) Feasibility of laparoscopic total proctocolectomy with ileal pouch-anal anastomosis and total colectomy with ileorectal anastomosis for familial adenomatous polyposis: results of a nationwide multicenter study. Int J Clin Oncol 21:953–961CrossRefGoogle Scholar
  2. 2.
    Vergara-Fernandez O, Mejía-Ovalle R, Salgado-Nesme N, Rodríguez-Dennen N, Pérez-Aguirre J, Guerrero-Guerrero VH et al (2014) Functional outcomes and quality of life in patients treated with laparoscopic total colectomy for colonic inertia. Surg Today 44:34–38CrossRefGoogle Scholar
  3. 3.
    Lubowski DZ, Chen FC, Kennedy ML, King DW (1996) Results of colectomy for severe slow transit constipation. Dis Colon Rectum 39:23–29CrossRefGoogle Scholar
  4. 4.
    Nakamura T, Pikarsky AJ, Potenti FM, Lau CW, Weiss EG, Nogueras JJ et al (2001) Are complications of subtotal colectomy with ileorectal anastomosis related to the original disease? Am Surg 67:417–420PubMedGoogle Scholar
  5. 5.
    Elton C, Makin G, Hitos K, Cohen CR (2003) Mortality, morbidity and functional outcome after ileorectal anastomosis. Br J Surg 90:59–65CrossRefGoogle Scholar
  6. 6.
    Brill AI, Nezhat F, Nezhat CH, Nezhat C (1995) The incidence of adhesions after prior laparotomy: a laparoscopic appraisal. Obstet Gynecol 85:269–272CrossRefGoogle Scholar
  7. 7.
    Levrant SG, Bieber EJ, Barnes RB (1997) Anterior abdominal wall adhesions after laparotomy or laparoscopy. J Am Assoc Gynecol Laparosc 4:353–356CrossRefGoogle Scholar
  8. 8.
    Pinedo G, Zarate AJ, Garcia E, Molina ME, Lopez F, Zúñiga A (2009) Laparoscopic total colectomy for colonic inertia: surgical and functional results. Surg Endosc 23:62–65CrossRefGoogle Scholar
  9. 9.
    Hsiao KC, Jao SW, Wu CC, Lee TY, Lai HJ, Kang JC (2008) Hand-assisted laparoscopic total colectomy for slow transit constipation. Int J Colorectal Dis 23:419–424CrossRefGoogle Scholar
  10. 10.
    Zhang X, Wu Q, Gu C, Hu T, Bi L, Wang Z (2019) Comparison of short and long-time outcomes between laparoscopic and conventional open multivisceral resection for primary T4b colorectal cancer. Asian J Surg 42:401–408CrossRefGoogle Scholar
  11. 11.
    Chen YT, Kiu KT, Yen MH, Chang TC (2018) Comparison of the short-term outcomes in lower rectal cancer using three different surgical techniques: transanal total mesorectal excision (TME), laparoscopic TME, and open TME. Asian J Surg. CrossRefPubMedGoogle Scholar
  12. 12.
    Komatsu S, Sakamoto E, Norimizu S, Shingu Y, Asahara T, Nomoto K et al (2016) Efficacy of perioperative synbiotics treatment for the prevention of surgical site infection after laparoscopic colorectal surgery: a randomized controlled trial. Surg Today 46:479–490CrossRefGoogle Scholar
  13. 13.
    Sadava EE, Kerman Cabo J, Carballo FH, Bun ME, Rotholtz NA (2014) Incisional hernia after laparoscopic colorectal surgery. Is there any factor associated? Surg Endosc 28:3421–3424CrossRefGoogle Scholar
  14. 14.
    Klaristenfeld DD, McLemore EC, Li BH, Abbass MA, Abbas MA (2015) Significant reduction in the incidence of small bowel obstruction and ventral hernia after laparoscopic compared to open segmental colorectal resection. Langenbecks Arch Surg 400:505–512CrossRefGoogle Scholar
  15. 15.
    Jeong WJ, Choi BJ, Lee SC (2019) Pure natural orifice transluminal endoscopic surgery for rectal cancer: ta-TME and CME without abdominal assistance. Asian J Surg 42:450–457CrossRefGoogle Scholar
  16. 16.
    Awad Z (2014) Laparoscopic total colectomy with transvaginal extraction of the colon and ileorectal anastomosis. Ann Surg Oncol 21:3029CrossRefGoogle Scholar
  17. 17.
    Lacy AM, Adelsdorfer C, Delgado S, Sylla P, Rattner DW (2013) Minilaparoscopy-assisted transrectal low anterior resection (LAR): a preliminary study. Surg Endosc 27:339–346CrossRefGoogle Scholar
  18. 18.
    Gundogan E, Kayaalp C, Gunes O, Uylas U, Sumer F (2019) A comparison of natural orifice versus transabdominal specimen extraction following laparoscopic total colectomy. J Laparoendosc Adv Surg Tech A 29:471–475CrossRefGoogle Scholar
  19. 19.
    Lightner AL, Kelley SR, Larson DW (2018) Robotic Platform for an IPAA. Dis Colon Rectum 61:869–874CrossRefGoogle Scholar
  20. 20.
    Liang JT, Huang J, Chen TC (2019) Standardize the surgical technique and clarify the relevant anatomic concept for complete mobilization of colonic splenic flexure using Da Vinci Xi® Robotic System. World J Surg 43:1129–1136CrossRefGoogle Scholar
  21. 21.
    Liang JT, Huang J, Chen TC, Hung JS (2019) The Toldt fascia: a historic review and surgical implications in complete mesocolic excision for colon cancer. Asian J Surg 42:1–5CrossRefGoogle Scholar
  22. 22.
    Zinner MJ, Ashley SW (2007) Maingot’s abdominal operations, 11th edn. McGraw Hill, New York, p 1443Google Scholar
  23. 23.
    Swank HA, Mulder IM, la Chapelle CF, Reitsma JB, Lange JF, Bemelman WA et al (2012) Systematic review of trocar-site hernia. Br J Surg 99:315–323CrossRefGoogle Scholar
  24. 24.
    Lv S, Wang Q, Zhao W, Han L, Wang Q, Batchu N et al (2017) A review of the postoperative lymphatic leakage. Oncotarget 8:69062–69075PubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Graduate Institute of Clinical Medicine, College of MedicineNational Taiwan UniversityTaipeiTaiwan, R.O.C.
  2. 2.Division of Colorectal Surgery, Department of SurgeryNational Taiwan University Hospital and College of MedicineTaipeiTaiwan, R.O.C.

Personalised recommendations