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Transvaginal rigid-hybrid natural orifice transluminal endoscopic surgery technique for anterior resection treatment of diverticulitis: a feasibility study

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Abstract

Background

In laparoscopic anterior resection, minilaparotomy still is required. Recently, transvaginal hybrid natural orifice transluminal endoscopic surgery (NOTES) techniques for cholecystectomy have been described. Reports on operations that require removal of larger specimens, as in anterior resection, are scarce and limited primarily to small case series and case reports. The current study aimed to evaluate the feasibility and safety of transvaginal rigid-hybrid NOTES anterior resection (tvAR) for symptomatic diverticular disease.

Methods

All female patients presenting with symptomatic diverticulitis of the sigmoid colon were candidates for inclusion in the study. The exclusion criteria specified failure to sign informed consent, previous colorectal resection, anesthesiologic contraindication for pneumoperitoneum, liver failure and coagulopathy, severe acute diverticular bleeding, internal fistula with abscess (Hinchey 2b), perforated diverticulitis with peritonitis (Hinchey 3 or 4), gynecologic or urologic contraindications, and absence of preoperative gynecologic examination. A preoperative and 2-week postoperative gynecologic examination was performed. Quality of life and sexual function were assessed preoperatively and 6 weeks postoperatively.

Results

Of 70 patients, 45 (64.3%) were scheduled for tvAR. Five patients were withdrawn at the beginning of laparoscopy with no transvaginal access performed. Of the remaining 40 patients with attempted tvAR, 4 patients underwent conversion to a minilaparotomy (Pfannenstiel incision) and 2 patients were converted to a total median laparotomy. For 34 patients (85%), the operation was completed transvaginally. A total of 2 major complications and 10 minor complications occurred. No serious postoperative gynecologic morbidity was experienced. At 6 weeks postoperatively, sexual function did not differ significantly from preoperative status.

Conclusions

For symptomatic diverticular disease, TvAR is feasible, although the presented technique requires laparoscopic expertise and further refinement.

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References

  1. Giday SA, Kantsevoy SV, Kalloo AN (2006) Principle and history of natural orifice translumenal endoscopic surgery (NOTES). Minim Invasive Ther Allied Technol 15:373–377

    Article  PubMed  Google Scholar 

  2. Rattner D, Kalloo A (2006) ASGE/SAGES Working Group on Natural Orifice Translumenal Endoscopic Surgery. October 2005. Surg Endosc 20:329–333

    Article  PubMed  CAS  Google Scholar 

  3. Zornig C, Emmermann A, von Waldenfels HA, Mofid H (2007) Laparoscopic cholecystectomy without visible scar: combined transvaginal and transumbilical approach. Endoscopy 39:913–915

    Article  PubMed  CAS  Google Scholar 

  4. Zornig C, Mofid H, Siemssen L, Emmermann A, Alm M, von Waldenfels HA, Felixmuller C (2009) Transvaginal NOTES hybrid cholecystectomy: feasibility results in 68 cases with midterm follow-up. Endoscopy 41:391–394

    Article  PubMed  CAS  Google Scholar 

  5. Ramos AC, Murakami A, Galvao Neto M, Galvao MS, Silva AC, Canseco EG, Moyses Y (2008) NOTES transvaginal video-assisted cholecystectomy: first series. Endoscopy 40:572–575

    Article  PubMed  Google Scholar 

  6. Bessler M, Stevens PD, Milone L, Parikh M, Fowler D (2007) Transvaginal laparoscopically assisted endoscopic cholecystectomy: a hybrid approach to natural orifice surgery. Gastrointest Endosc 66:1243–1245

    Article  PubMed  Google Scholar 

  7. Decarli LA, Zorron R, Branco A, Lima FC, Tang M, Pioneer SR, Sanseverino JI, Menguer R, Bigolin AV, Gagner M (2009) New hybrid approach for NOTES transvaginal cholecystectomy: preliminary clinical experience. Surg Innov 16:181–186

    Article  PubMed  Google Scholar 

  8. Decarli L, Zorron R, Branco A, Lima FC, Tang M, Pioneer SR, Zanin I Jr, Schulte AA, Bigolin AV, Gagner M (2008) Natural orifice translumenal endoscopic surgery (NOTES) transvaginal cholecystectomy in a morbidly obese patient. Obes Surg 18:886–889

    Article  PubMed  Google Scholar 

  9. Noguera J, Dolz C, Cuadrado A, Olea J, Vilella A, Morales R (2009) Hybrid transvaginal cholecystectomy, NOTES, and minilaparoscopy: analysis of a prospective clinical series. Surg Endosc 23:876–881

    Article  PubMed  Google Scholar 

  10. Pugliese R, Forgione A, Sansonna F, Ferrari GC, Di Lernia S, Magistro C (2009) Hybrid NOTES transvaginal cholecystectomy: operative and long-term results after 18 cases. Langenbecks Arch Surg 395:241–245

    Article  PubMed  Google Scholar 

  11. Ghezzi F, Raio L, Mueller MD, Gyr T, Buttarelli M, Franchi M (2002) Vaginal extraction of pelvic masses following operative laparoscopy. Surg Endosc 16:1691–1696

    Article  PubMed  CAS  Google Scholar 

  12. Ebert AD, Burkhardt T, Parlayan S, Riediger H, Papadopoulos T (2009) Transvaginal-laparoscopic anterior rectum resection in a hysterectomized woman with deep-infiltrating endometriosis: description of a gynecologic natural orifice transendoluminal surgery approach. J Minim Invasive Gynecol 16:231–235

    Article  PubMed  Google Scholar 

  13. Ghezzi F, Cromi A, Ciravolo G, Rampinelli F, Braga M, Boni L (2008) A new laparoscopic-transvaginal technique for rectosigmoid resection in patients with endometriosis. Fertil Steril 90:1964–1968

    Article  PubMed  Google Scholar 

  14. Breitenstein S, Dedes KJ, Bramkamp M, Hess T, Decurtins M, Clavien PA (2006) Synchronous laparoscopic sigmoid resection and hysterectomy with transvaginal specimen removal. J Laparoendosc Adv Surg Tech A 16:286–289

    Article  PubMed  Google Scholar 

  15. Abrao MS, Sagae UE, Gonzales M, Podgaec S, Dias JA Jr (2005) Treatment of rectosigmoid endometriosis by laparoscopically assisted vaginal rectosigmoidectomy. Int J Gynaecol Obstet 91:27–31

    Article  PubMed  CAS  Google Scholar 

  16. Lacy AM, Delgado S, Rojas OA, Almenara R, Blasi A, Llach J (2008) MA-NOS radical sigmoidectomy: report of a transvaginal resection in the human. Surg Endosc 22:1717–1723

    Article  PubMed  Google Scholar 

  17. Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6.336 patients and results of a survey. Ann Surg 240:205–213

    Article  PubMed  Google Scholar 

  18. Eypasch E, Wood-Dauphinee S, Williams JI, Ure B, Neugebauer E, Troidl H (1993) The Gastrointestinal Quality of Life Index: a clinical index for measuring patient status in gastroenterologic surgery. Chirurg 64:264–274

    PubMed  CAS  Google Scholar 

  19. Shafik A, Mostafa RM, Shafik AA (2002) Electrophysiological study of the rectosigmoid canal: evidence of a rectosigmoid sphincter. J Anat 200:517–521

    Article  PubMed  Google Scholar 

  20. Guller U, Jain N, Hervey S, Purves H, Pietrobon R (2003) Laparoscopic vs open colectomy: outcomes comparison based on large nationwide databases. Arch Surg 138:1179–1186

    Article  PubMed  Google Scholar 

  21. Guller U, Rosella L, Karanicolas PJ, Adamina M, Hahnloser D (2010) Population-based trend analysis of 2,813 patients undergoing laparoscopic sigmoid resection. Br J Surg 97:79–85

    Article  PubMed  CAS  Google Scholar 

  22. Klarenbeek BR, Veenhof AA, Bergamaschi R, van der Peet DL, van den Broek WT, de Lange ES, Bemelman WA, Heres P, Lacy AM, Engel AF, Cuesta MA (2009) Laparoscopic sigmoid resection for diverticulitis decreases major morbidity rates: a randomized control trial: short-term results of the Sigma Trial. Ann Surg 249:39–44

    Article  PubMed  Google Scholar 

  23. Martel G, Boushey RP (2006) Laparoscopic colon surgery: past, present, and future. Surg Clin N Am 86:867–897

    Article  PubMed  Google Scholar 

  24. Nelson H, Sargent DJ, Wieand H (2004) A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med 350:2050–2059

    Article  CAS  Google Scholar 

  25. Winslow ER, Fleshman JW, Birnbaum EH, Brunt LM (2002) Wound complications of laparoscopic vs open colectomy. Surg Endosc 16:1420–1425

    Article  PubMed  CAS  Google Scholar 

  26. Boni L, Benevento A, Rovera F, Dionigi G, Di Giuseppe M, Bertoglio C, Dionigi R (2006) Infective complications in laparoscopic surgery. Surg Infect (Larchmt) 7(Suppl 2):S109–S111

    Google Scholar 

  27. McGee MF, Rosen MJ, Marks J, Onders RP, Chak A, Faulx A, Chen VK, Ponsky J (2006) A primer on natural orifice transluminal endoscopic surgery: building a new paradigm. Surg Innov 13:86–93

    Article  PubMed  Google Scholar 

  28. Grande M, Tucci GF, Adorisio O, Barini A, Rulli F, Neri A, Franchi F, Farinon AM (2002) Systemic acute-phase response after laparoscopic and open cholecystectomy. Surg Endosc 16:313–316

    Article  PubMed  CAS  Google Scholar 

  29. Karayiannakis AJ, Makri GG, Mantzioka A, Karousos D, Karatzas G (1997) Systemic stress response after laparoscopic or open cholecystectomy: a randomized trial. Br J Surg 84:467–471

    Article  PubMed  CAS  Google Scholar 

  30. Burpee SE, Kurian M, Murakame Y, Benevides S, Gagner M (2002) The metabolic and immune response to laparoscopic versus open liver resection. Surg Endosc 16:899–904

    Article  PubMed  CAS  Google Scholar 

  31. Holmdahl L, Eriksson E, Eriksson BI, Risberg B (1998) Depression of peritoneal fibrinolysis during operation is a local response to trauma. Surgery 123:539–544

    Article  PubMed  CAS  Google Scholar 

  32. Swank DJ, Van Erp WF, Repelaer Van Driel OJ, Hop WC, Bonjer HJ, Jeekel H (2003) A prospective analysis of predictive factors on the results of laparoscopic adhesiolysis in patients with chronic abdominal pain. Surg Laparosc Endosc Percutan Tech 13:88–94

    Article  PubMed  Google Scholar 

  33. Milingos S, Kallipolitis G, Loutradis D, Liapi A, Mavrommatis K, Drakakis P, Tourikis J, Creatsas G, Michalas S (2000) Adhesions: laparoscopic surgery versus laparotomy. Ann N Y Acad Sci 900:272–285

    Article  PubMed  CAS  Google Scholar 

  34. Redwine DB, Koning M, Sharpe DR (1996) Laparoscopically assisted transvaginal segmental resection of the rectosigmoid colon for endometriosis. Fertil Steril 65:193–197

    PubMed  CAS  Google Scholar 

  35. Zornig C, Emmermann A, von Waldenfels HA, Felixmuller C (1994) Colpotomy for specimen removal in laparoscopic surgery. Chirurg 65:883–885

    PubMed  CAS  Google Scholar 

  36. Linke GR, Tarantino I, Hoetzel R, Warschkow R, Lange J, Lachat R, Zerz A (2010) Transvaginal rigid-hybrid NOTES cholecystectomy: evaluation in routine clinical practice. Endoscopy 42:571–575

    Article  PubMed  CAS  Google Scholar 

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Acknowledgment

The authors thank Armin Schlegel, Spital Rorschach, Rorschach, Switzerland, for his support in the daily operative routine.

Disclosures

Ignazio Tarantino, Georg R. Linke, Jochen Lange, Ikbale Siercks, René Warschkow, and Andreas Zerz have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Department of Surgery, Kantonsspital St. Gallen, 9007, St. Gallen, Switzerland

    Ignazio Tarantino, Jochen Lange & René Warschkow

  2. Department of General, Abdominal and Transplant Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany

    Georg R. Linke

  3. Department of Gynaecology, Kantonsspital St. Gallen, 9007, St. Gallen, Switzerland

    Ikbale Siercks

  4. Department of Surgery, Kantonsspital Bruderholz, 4101, Bruderholz, Switzerland

    Andreas Zerz

Authors
  1. Ignazio Tarantino
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  2. Georg R. Linke
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  3. Jochen Lange
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  4. Ikbale Siercks
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  5. René Warschkow
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  6. Andreas Zerz
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Correspondence to Ignazio Tarantino.

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Tarantino, I., Linke, G.R., Lange, J. et al. Transvaginal rigid-hybrid natural orifice transluminal endoscopic surgery technique for anterior resection treatment of diverticulitis: a feasibility study. Surg Endosc 25, 3034–3042 (2011). https://doi.org/10.1007/s00464-011-1666-5

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