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An experimental study in six fresh human cadavers using a novel approach to avoid abdominal wall incisions in total colectomy: totally transanal laparoendoscopic single-site pull-through colectomy with J-pouch creation

Abstract

Background

The use of transanal laparoscopic access to completely avoid abdominal wall incisions represents the most current evolution in minimally invasive surgery. The combination of single-site surgery and natural orifice transluminal endoscopic surgery (NOTES™) can be used for totally transanal laparoendoscopic pull-through colectomy with J-pouch creation (TLPC-J). The aim of the present study was to provide evidence for the feasibility of TLPC-J in adult human cadavers.

Methods

TLPC-J was performed in six fresh adult human cadavers. The procedure involved endorectal submucosal dissection from 1 cm above the dentate line to a point above the peritoneal reflection, where the rectal muscle was divided circumferentially. The edge of the mucosal cuff was closed distally in order to prevent fecal contamination and the endorectal tube was placed back into the abdomen. A Triport+™ or QuadPort+™ system was introduced transanally, and it served as a multiport device (MD). Resection of the entire colon, mobilization of the distal ileal segment, and extracorporeal suture of the ileal J-loop were performed via the transanal approach. The J-pouch was created using Endo GIA™. After removal of the MD, the J-pouch was sutured to the rectal wall.

Results

TLPC-J was performed in all cadavers, with a mean operation duration of 236 ± 22 min. Conversion to either transabdominal laparoscopy or laparotomy was not required in any of the cadavers. No bowel perforation or damage to other organs was observed. The use of a curved endoscope greatly facilitated visualization during transanal laparoscopic dissection for partial and total colectomy, making the procedure feasible. All specimens were retrieved through the anus, eliminating the need for additional transabdominal incisions.

Conclusions

TLPC-J was technically feasible in adult human cadavers, and abdominal wall incisions were not required. However, clinical studies are needed to determine its feasibility in living adults.

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Acknowledgments

We thank Mrs. Charlotte Schmitz (CATSNFROGS Medical Illustrations) for illustrating the steps of the surgical procedure. Additionally, we thank Editage (www.editage.com) for English language editing.

Author information

Correspondence to M. Reza Vahdad.

Ethics declarations

Disclosures

M. Reza Vahdad and Harry Zemon are consultants for Olympus Surgical Technologies. Samuel Faran is an employee of Olympus Surgical Technologies. Grigore Cernaianu, Alexander Semaan, Tobias Klein, Thomas Boemers, and Hamid Reza Foroutan have no conflicts of interest or financial ties to disclose.

Additional information

Presented at the SAGES 2015 Annual Meeting, April 15–18, 2015, Nashville, Tennessee.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Transanal laparoscopic bowel dissection between the rectum and the left colonic flexure (WMV 32825 kb)

Transanal laparoscopic bowel resection between the transverse colon and the ascending colon, and transanal extraction of the resected bowel (WMV 21794 kb)

Video 1

Transanal laparoscopic bowel dissection between the rectum and the left colonic flexure (WMV 32825 kb)

Video 2

Transanal laparoscopic bowel resection between the transverse colon and the ascending colon, and transanal extraction of the resected bowel (WMV 21794 kb)

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Vahdad, M.R., Cernaianu, G., Semaan, A. et al. An experimental study in six fresh human cadavers using a novel approach to avoid abdominal wall incisions in total colectomy: totally transanal laparoendoscopic single-site pull-through colectomy with J-pouch creation. Surg Endosc 30, 3107–3113 (2016). https://doi.org/10.1007/s00464-015-4555-5

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Keywords

  • Natural orifice transluminal endoscopic surgery
  • Transanal minimally invasive surgery
  • Colectomy
  • Transanal