Skip to main content
SpringerLink
Log in

Prospective Randomized Trial of Hybrid NOTES Colectomy Versus Conventional Laparoscopic Colectomy for Left-sided Colonic Tumors

  • Published:
World Journal of Surgery Aims and scope Submit manuscript

Abstract

Background

We conducted a randomized study of a laparoscopic technique for removing left-sided colon tumors that can reduce postoperative pain and other wound-related complications compared to the conventional technique. It is a novel technique of hybrid natural orifice translumenal endoscopic surgery (NOTES) colectomy (HNC) whereby laparoscopic colonic mobilization, transection, and anastomosis are performed intracorporeally. The specimen is then delivered through the anus using the transanal endoscopic operation (TEO) device, precluding the need for mini-laparotomy. We compared the short-term outcomes of patients who underwent HNC with those who underwent conventional laparoscopic colectomy (CL).

Methods

Patients suffering left-sided colonic tumor were recruited and were randomized into two groups: HNC and CL. Operative data and complications were prospectively recorded and analyzed.

Results

During a 3-year period, we recruited 70 patients (35 per group). No significant difference was observed between the two groups with respect to operating time (105 vs. 100 min, p = 0.851), blood loss (30 vs. 30 ml, p = 0.954), or length of hospital stay (5 vs. 5 days, p = 0.990). The maximum pain score during the first week was significantly lower in the HNC group (1 vs. 2, p = 0.017). No patients in the HNC group developed wound infection, whereas four patients in the CL group did so (p = 0.005).

Conclusions

With this hybrid NOTES technique, selected patients with left-sided colonic tumors can enjoy the full benefits of minimally invasive surgery with significantly less wound pain and a lower wound infection rate than are observed with CL.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Cheung HYS, Leung ALH, Chung CC et al (2009) Endo-laparoscopic colectomy without mini-laparotomy for left-sided colonic tumors. World J Surg 33:1287–1291. doi:10.1007/s00268-009-0006-6

    Article  PubMed  Google Scholar 

  2. Clinical Outcomes of Surgical Therapy Study Group (2004) A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med 350:2050–2059

    Article  Google Scholar 

  3. Veldkamp R, Kuhry E, Hop WC et al (2005) Laparoscopic surgery vs. open surgery for colon cancer: short-term outcomes of a randomised trial. Lancet Oncol 6:477–484

    Article  PubMed  Google Scholar 

  4. Guillou PJ, Quirke P, Thorpe H et al (2005) Short-term endpoints of conventional vs. laparoscopic assisted surgery in patients with colorectal cancer (MRC CLASSIC trial): multicenter, randomised controlled trial. Lancet 365:1718–1726

    Article  PubMed  Google Scholar 

  5. Willingham FF, Brugge WR (2007) Taking NOTES: translumenal flexible endoscopy and endoscopic surgery. Curr Opin Gastroenterol 23:550–555

    Article  PubMed  Google Scholar 

  6. Flora ED, Wilson TG, Martin IJ et al (2008) A review of natural orifice translumenal endoscopic surgery (NOTES) for intra-abdominal surgery experimental models, techniques, and applicability to the clinical setting. Ann Surg 247:583–602

    Article  PubMed  Google Scholar 

  7. Whiteford MH, Denk PM, Swanström LL (2007) Feasibility of radical sigmoid colectomy performed as natural orifice translumenal endoscopic surgery (NOTES) using transanal endoscopic microsurgery. Surg Endosc 21:1870–1874

    Article  PubMed  CAS  Google Scholar 

  8. Sylla P, Rattner DW, Delgado S et al (2010) NOTES transanal rectal cancer resection using transanal endoscopic microsurgery and laparoscopic assistance. Surg Endosc 24:1205–1210

    Article  PubMed  Google Scholar 

  9. Sylla P, Lacy AM (2011) NOTES transanal rectal cancer resection using transanal endoscopic microsurgery. Eur Surg 43(3):146–152

    Article  Google Scholar 

  10. Hara M, Takayama S, Sato M et al (2011) Laparoscopic anterior resection for colorectal cancer without minilaparotomy using transanal bowel reversing retrieval. Surg Laparosc Endosc Percutan Tech 21:e235–e238

    Article  PubMed  Google Scholar 

  11. Nishimura A, Kawahara M, Suda K et al (2011) Totally laparoscopic sigmoid colectomy with transanal specimen extraction. Surg Endosc 25:3459–3463

    Article  PubMed  Google Scholar 

  12. Leroy J, Costantino F, Cahill RA et al (2011) Laparoscopic resection with transanal specimen extraction for sigmoid diverticulitis. Br J Surg 98:1327–1334

    Article  PubMed  CAS  Google Scholar 

  13. Knol J, D’Hondt MD’, Dozois EJ et al (2009) Laparoscopic-assisted sigmoidectomy with transanal specimen extraction: a bridge to NOTES? Tech Coloproctol 13:65–68

    Article  PubMed  CAS  Google Scholar 

  14. Saad S, Hosogi H (2011) Laparoscopic left colectomy combined with natural orifice access: operative technique and initial results. Surg Endosc 25:2742–2747

    Article  PubMed  Google Scholar 

  15. Diana M, Wall J, Costantino F et al (2011) Transanal extraction of the specimen during laparoscopic colectomy. Colorectal Dis 13(Suppl 7):23–27

    Article  PubMed  Google Scholar 

  16. Choi GS, Park IJ, Kang BM et al (2009) A novel approach of robotic-assisted anterior resection with transanal or transvaginal retrieval of the specimen for colorectal cancer. Surg Endosc 23:2831–2835

    Article  PubMed  Google Scholar 

  17. Franklin ME Jr, Liang S, Russek K (2013) Natural orifice specimen extraction in laparoscopic colorectal surgery: transanal and transvaginal approaches. Tech Coloproctol 17 Suppl 1:S63–S67

    Google Scholar 

  18. Park JS, Choi GS, Kim HJ et al (2011) Natural orifice specimen extraction versus conventional laparoscopically assisted right hemicolectomy. Br J Surg 98:710–715

    Article  PubMed  CAS  Google Scholar 

  19. Diana M, Perretta S, Wall J et al (2011) Transvaginal specimen extraction in colorectal surgery: current state of the art. Colorectal Dis 13:e104–e111

    Article  PubMed  CAS  Google Scholar 

  20. Leroy J, Diana M, Wall J et al (2011) Laparo-endoscopic single-site (LESS) with transanal natural orifice specimen extraction (NOSE) sigmoidectomy: a new step before pure colorectal natural orifices transluminal endoscopic surgery (NOTES®). J Gastrointest Surg 15:1488–1492

    Article  PubMed  Google Scholar 

  21. Franklin ME Jr, Liang S, Russek K (2013) Integration of transanal specimen extraction into laparoscopic anterior resection with total mesorectal excision for rectal cancer: a consecutive series of 179 patients. Surg Endosc 27:127–132

    Article  PubMed  Google Scholar 

  22. Costantino FA, Diana M, Wall J et al (2012) Prospective evaluation of peritoneal fluid contamination following transabdominal vs. transanal specimen extraction in laparoscopic left-sided colorectal resections. Surg Endosc 26:1495–1500

    Article  PubMed  Google Scholar 

  23. Makris KI, Rieder E, Kastenmeier AS et al (2012) Transanal specimen retrieval using the transanal endoscopic microsurgery (TEM) system in minimally invasive colon resection. Surg Endosc 26:1161–1162

    Article  PubMed  Google Scholar 

  24. Saad S, Hosogi H (2010) Natural orifice specimen extraction for avoiding laparotomy in laparoscopic left colon resections: a new approach using the McCartney tube and the tilt top anvil technique. J Laparoendosc Adv Surg Technol A 20:689–692

    Article  Google Scholar 

  25. Wolthuis AM, Van Geluwe B, Fieuws S et al (2011) Laparoscopic sigmoid resection with transrectal specimen extraction: a systematic review. Colorectal Dis 14:1183–1190

    Article  Google Scholar 

Download references

Conflict of interest

None.

Financial disclosure

None.

Author information

Authors and Affiliations

  1. Department of Surgery, Pamela Youde Nethersole Eastern Hospital, 3 Lok Man Road, Chai Wan, Hong Kong SAR, China

    Alex Lik Hang Leung, Hester Yui Shan Cheung, Benny Ka Lung Fok, Cliff Chi Chiu Chung, Michael Ka Wah Li & Chung Ngai Tang

Authors
  1. Alex Lik Hang Leung
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hester Yui Shan Cheung
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Benny Ka Lung Fok
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Cliff Chi Chiu Chung
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Michael Ka Wah Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Chung Ngai Tang
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Alex Lik Hang Leung.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Leung, A.L.H., Cheung, H.Y.S., Fok, B.K.L. et al. Prospective Randomized Trial of Hybrid NOTES Colectomy Versus Conventional Laparoscopic Colectomy for Left-sided Colonic Tumors . World J Surg 37, 2678–2682 (2013). https://doi.org/10.1007/s00268-013-2163-x

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00268-013-2163-x

Keywords

Search

Navigation