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DOI: 10.1055/s-0030-1255978
© Georg Thieme Verlag KG Stuttgart · New York
Hybrid laparoscopic colectomy with transluminal colonoscopic specimen extraction – a step toward natural orifice surgery
S. Saad
Department of General Surgery
Clinic Gummersbach
Wilhelm-Breckow-Allee 20
51643 Gummersbach
Germany
Fax: +49-2261-17-1615
Email: stefansaad@aol.com
Publication History
Publication Date:
17 December 2010 (online)
Minimally invasive surgery is the method of choice when colon polyps cannot be removed endoscopically. However, laparoscopic colon resections require a 5 – 6-cm minilaparotomy to retrieve the specimen. This laparotomy can cause pain, wound infection, and hernia formation [1] [2]. We describe a new technique to avoid a minilaparotomy by using a flexible colonoscope for transluminal specimen extraction.
A 70-year-old woman with a polyp in the mid-transverse colon was laparoscopically operated with four trocars (2 × 5 mm, 2 × 5 – 12 mm). Preoperative workup was standard, including bowel preparation. Briefly, laparoscopic dissection consisted of colon mobilization of the hepatic and splenic flexures. The mesentery of the transverse colon was transsected by a 5-mm Ligasure device (Valleylab, Boulder, Colorado, USA) respecting oncologic principles. Linear Endo-GIAs (6 cm, blue cartridge, Tyco Healthcare, Norwalk, Connecticut, USA) were used to cut the bowel along the defined proximal and distal resection lines to obtain the specimen. A flexible colonoscope was guided to the end of the distal colon. The colon was opened and the specimen grasped with a wire loop ([Fig. 1]).
The specimen together with the colonoscope was then carefully pulled through the distal colon and the anus. The colon was again closed with an Endo-GIA. The resulting tiny colon remnant was removed through one 12-mm trocar. A stapled side-to-side colon anastomosis was carried out and port sites were sutured intracutaneously. Postoperative pain was solely managed by paracetamol. After an uneventful postoperative course the patient was discharged 5 days after the operation.
Natural orifice (transvaginal/transanal) specimen extraction has been described [3] [4] [5] to avoid laparotomy for laparoscopic colectomy, but these techniques are limited to female patients or to lesions of the recto-sigmoid colon. Our hybrid approach enables surgeons to perform totally laparoscopic colectomies without laparotomy in order to reduce incision-related morbidity.
Competing interests: None
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#References
- 1 Winslow E R, Fleshmann J W, Birnbaum E H, Brunt L M. Wound complications of laparoscopic vs open colectomy. Surg Endosc. 2002; 16 1420-1425
- 2 Singh R, Omicciolo A, Hegge S, McKinley C. Does the extraction-site location in laparoscopic colorectal surgery have an impact on incisional hernia rates?. Surg Endosc. 2008; 22 2596-2600
- 3 Franklin M E, Kelley H, Kelley M. et al . Transvaginal extraction of the specimen after total laparoscopic right hemicolectomy with intracorporal anastomosis. Surg Laparosc Endosc Tech. 2008; 18 294-298
- 4 Ooi B S, Quah H M, Fu C WP, Eu K W. Laparoscopic high anterior resection with natural orifice specimen extraction (NOSE) for early rectal cancer. Tech Coloproctol. 2009; 134 61-64
- 5 Cheung H YS, Leung A LH, Chung C C, Li M KW. Endo-laparoscopic colectomy without mini-laparotomy for left-sided colonic tumors. World J Surg. 2009; 33 1287-1291
S. Saad
Department of General Surgery
Clinic Gummersbach
Wilhelm-Breckow-Allee 20
51643 Gummersbach
Germany
Fax: +49-2261-17-1615
Email: stefansaad@aol.com
References
- 1 Winslow E R, Fleshmann J W, Birnbaum E H, Brunt L M. Wound complications of laparoscopic vs open colectomy. Surg Endosc. 2002; 16 1420-1425
- 2 Singh R, Omicciolo A, Hegge S, McKinley C. Does the extraction-site location in laparoscopic colorectal surgery have an impact on incisional hernia rates?. Surg Endosc. 2008; 22 2596-2600
- 3 Franklin M E, Kelley H, Kelley M. et al . Transvaginal extraction of the specimen after total laparoscopic right hemicolectomy with intracorporal anastomosis. Surg Laparosc Endosc Tech. 2008; 18 294-298
- 4 Ooi B S, Quah H M, Fu C WP, Eu K W. Laparoscopic high anterior resection with natural orifice specimen extraction (NOSE) for early rectal cancer. Tech Coloproctol. 2009; 134 61-64
- 5 Cheung H YS, Leung A LH, Chung C C, Li M KW. Endo-laparoscopic colectomy without mini-laparotomy for left-sided colonic tumors. World J Surg. 2009; 33 1287-1291
S. Saad
Department of General Surgery
Clinic Gummersbach
Wilhelm-Breckow-Allee 20
51643 Gummersbach
Germany
Fax: +49-2261-17-1615
Email: stefansaad@aol.com