Abstract
Background
The techniques of intracorporeal anastomosis and specimen extraction after laparoscopic colectomy via a natural orifice have gained interest increasingly. We evaluated the feasibility of our unique techniques for colorectal reconstruction and report immediate postoperative outcomes in patients with rectosigmoid cancer.
Methods
Patients with sigmoid or rectal cancer were selected depending on the size of the tumor and its distance from the anal verge. Demographic data, operative parameters, and postoperative outcomes were assessed. After complete resection of the tumor, all patients underwent an intracorporeal side-to-end colorectal anastomosis following transrectal specimen extraction.
Results
Laparoscopic resection with our technique of intracorporeal anastomosis was successful in 32 patients. The average operative time was 192 ± 29 min, and mean blood loss was 51 ± 18 ml. All patients experienced mild postoperative pain, and bowel function returned before postoperative day 3 in most patients. They had an uneventful postoperative course with a median hospital stay of 6 days. Major perioperative complications or anastomotic leak were not encountered in this study. The mean size of the lesion was 3.3 ± 1.8 cm, and the mean number of harvested nodes was 14 ± 6. During the follow-up period, there were no functional disorders associated with the intracorporeal anastomosis or transrectal specimen extraction.
Conclusions
Intracorporeal side-to-end colorectal anastomosis with transrectal specimen extraction in laparoscopic colorectal surgery is a safe and effective procedure for patients with rectosigmoid malignancy.
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References
Palanivelu C, Rangarajan M, Jategaonkar PA, Anand NV. An innovative technique for colorectal specimen retrieval: a new era of “natural orifice specimen extraction” (N.O.S.E). Dis Colon Rectum. 2008;51:1120–4.
Leroy J, Costantino F, Cahill RA, et al. Laparoscopic resection with transanal specimen extraction for sigmoid diverticulitis. Br J Surg. 2011;98:1327–34.
Akamatsu H, Omori T, Oyama T, et al. Totally laparoscopic sigmoid colectomy: a simple and safe technique for intracorporeal anastomosis. Surg Endosc. 2009;23:2605–9.
Franklin ME Jr, Kelley H, Kelley M, et al. Transvaginal extraction of the specimen after total laparoscopic right hemicolectomy with intracorporeal anastomosis. Surg Laparosc Endosc Percutan Tech. 2008;18:294–8.
Knol J, D’Hondt M, Dozois EJ, Vanden Boer J, Malisse P. Laparoscopic-assisted sigmoidectomy with transanal specimen extraction: a bridge to NOTES? Tech Coloproctol. 2009;13:65–8.
Inoue Y, Noro H, Komoda H, et al. Completely laparoscopic total colectomy for chronic constipation: report of a case. Surg Today. 2002;32(6):551–4.
Wolthuis AM, Meuleman C, Tomassetti C, et al. Laparoscopic sigmoid resection with transrectal specimen extraction: a novel technique for the treatment of bowel endometriosis. Hum Reprod. 2011;26:1348–55.
Msika S, Iannelli A, Flamant Y, Hay JM. Laparoscopic sigmoid colectomy with intracorporeal hand-sewn anastomosis. Surg Endosc. 2000;14:866.
Park JS, Choi GS, Kim HJ, Park SY, Jun SH. Natural orifice specimen extraction versus conventional laparoscopically assisted right hemicolectomy. Br J Surg. 2011;98:710–5.
Nishimura A, Kawahara M, Suda K, et al. Totally laparoscopic sigmoid colectomy with transanal specimen extraction. Surg Endosc. 2011;25:3459–63.
Grams J, Tong W, Greenstein AJ, Salky B. Comparison of intracorporeal versus extracorporeal anastomosis in laparoscopic-assisted hemicolectomy. Surg Endosc. 2010;24:1886–91.
Franklin ME Jr, Liang S, Russek K. Natural orifice specimen extraction in laparoscopic colorectal surgery: transanal and transvaginal approaches. Tech Coloproctol. 2013;17(Suppl 1):S63–7.
Bucher P, Wutrich P, Pugin F, et al. Totally intracorporeal laparoscopic colorectal anastomosis using circular stapler. Surg Endosc. 2008;22:1278–82.
Makela J, Kivniemi H, Laitinene S. Risk factors for anastomotic leakage after left-sided colorectal resection with rectal anastomosis. Dis Colon Rectum. 2003;46(5):653–60.
Ooi BS, Quah HM, Fu CW, Eu KW. Laparoscopic high anterior resection with natural orifice specimen extraction (NOSE) for early rectal cancer. Tech Coloproctol. 2009;13:61–4.
Machado M, Nygren J, Goldman S, Ljungqvist O. Similar outcome after colonic pouch and side-to-end anastomosis in low anterior resection for rectal cancer: a prospective randomized trial. Ann Surg. 2003;238:214–20.
Fabozzi M, Allieta R, Contul RB, et al. Comparison of short- and medium-term results between laparoscopically assisted and totally laparoscopic right hemicolectomy: a case-control study. Surg Endosc. 2010;24: 2085–91.
Wolthuis AM, de Buck van Overstraeten A, D’Hoore A. Laparoscopic natural orifice specimen extraction-colectomy: a systematic review. World J Gastroenterol. 2014;20:12981–92.
Costantino FA, Diana M, Wall J, et al. Prospective evaluation of peritoneal fluid contamination following transabdominal vs. transanal specimen extraction in laparoscopic left-sided colorectal resections. Surg Endosc. 2012;26:1495–500.
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Huang, CC., Chen, YC., Huang, CJ. et al. Totally Laparoscopic Colectomy with Intracorporeal Side-to-End Colorectal Anastomosis and Transrectal Specimen Extraction for Sigmoid and Rectal Cancers. Ann Surg Oncol 23, 1164–1168 (2016). https://doi.org/10.1245/s10434-015-4984-3
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DOI: https://doi.org/10.1245/s10434-015-4984-3