Minilaparoscopy-assisted transrectal low anterior resection (LAR): a preliminary study

被引:70
作者
Lacy, Antonio M. [1 ]
Adelsdorfer, Cedric [1 ]
Delgado, Salvadora [1 ]
Sylla, Patricia [2 ]
Rattner, David W. [2 ]
机构
[1] Univ Barcelona, Dept Gastrointestinal Surg, Inst Digest & Metab Dis ICMDM, Hosp Clin,IDIBAPS,CIBERehd,Ctr Esther Koplowitz, Barcelona, Spain
[2] Massachusetts Gen Hosp, Div Gastrointestinal Surg, Boston, MA 02114 USA
来源
SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES | 2013年 / 27卷 / 01期
关键词
NOTES; MA-NOS; Minimally invasive surgery; Transrectal; Rectal cancer; TRANSANAL ENDOSCOPIC MICROSURGERY; INTRACORPOREAL RECTAL TRANSECTION; RANDOMIZED CLINICAL-TRIAL; TOTAL MESORECTAL EXCISION; DOUBLE-STAPLING TECHNIQUE; LONG-TERM OUTCOMES; ANASTOMOTIC LEAKAGE; RISK-FACTORS; COLON-CANCER; OPEN COLECTOMY;
D O I
10.1007/s00464-012-2443-9
中图分类号
R61 [外科手术学];
学科分类号
摘要
Natural orifice translumenal endoscopic surgery (NOTES) represents the evolution of surgery towards less invasive procedures. The feasibility of NOTES transrectal approach has increased its clinical applicability. This report describes a first series of minilaparoscopy-assisted transrectal low anterior resection with double purse-string end-to-end circular stapler anastomoses. Between March and April 2012 three selected patients underwent transrectal minilaparoscopy-assisted natural orifice surgery total mesorectal excision for rectal cancer. All the oncologic principles of open/laparoscopic low anterior resection for rectal cancer were strictly fulfilled. Two patients underwent neoadjuvant treatment. Laparoscopic visualization and assistance was provided through one 10-mm umbilical port and two ports, one of which was used as stoma site (5 mm) and the other as a drain site (2 mm needle port). The specimen was transected transanally followed by the confection of double purse-string lateral/end-to-end anastomoses. There were no intraoperative complications. Mean operative time was 143 min. Oral intake was initiated on the second postoperative day. Patients were discharged home by day 5. The pathology unit confirmed that distal and circumferential margins were free of tumor invasion, and quality of mesorectum resection was reported satisfactory. One patient had to be readmitted because of severe dehydration due to increased ileostomy output. The patient was discharged at the third day after the readmission without renal failure. In this preliminary report, transrectal minilaparoscopy-assisted low anterior resection was feasible and safe. Lateral/end-to-end anastomoses can be considered an interesting alternative to the double-stapling technique. However, it is necessary to further study and develop these procedures, along with careful patient selection, before transrectal low anterior resection may be considered for routine clinical use.
引用
收藏
页码:339 / 346
页数:8
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