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. 2017 May 24;1(1):24-29.
doi: 10.1002/bjs5.4. eCollection 2017 Feb.

Natural orifice transluminal endoscopic surgery for colorectal cancer

P N Hiep  1 , H H Thien  1 , P A Vu  2 , P H Thanh  1 , N T Xuan  1
Affiliations

Natural orifice transluminal endoscopic surgery for colorectal cancer

P N Hiep et al. BJS Open. .

Abstract

Background: Natural orifice transluminal endoscopic surgery (NOTES) has theoretical advantages over other approaches.

Methods: This was a prospective cohort study of colorectal cancers operated on by NOTES (transanally for rectal tumours, transvaginally for sigmoid tumours) between December 2013 and December 2015, with a minimum follow-up of 1 year. Eligibility criteria included ASA fitness grade I-III, BMI below 25 kg/m2 and TNM stage T3 N0 M0. Exclusion criteria included pregnancy or distant metastasis. The anastomosis was either handsewn or performed mechanically.

Results: Sixteen patients were operated on by a transanal and four by a transvaginal approach. There were ten men and ten women, with a mean(s.d.) age of 55·6(12·1) years. Mean BMI was 22·4(2·6) kg/m2. Four anterior, 11 low anterior and five intersphincteric resections were performed for 16 rectal and four low sigmoid tumours. The mean duration of surgery was 258(11) min. No conversion to laparotomy was needed, and there were no deaths. Five patients required additional ports, for intraoperative bleeding (1), suture of an intraoperative urethral injury with covering ileostomy (1) and difficulty in dissection (3). One patient had an anastomotic leak requiring transanal closure and ileostomy on day 7. Both ileostomies were closed after 2 months. The mean hospital stay was 6·4(1·8) days. All resections were R0.

Conclusion: In carefully selected patients NOTES for colorectal cancer resection was feasible and effective.

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Figures

Figure 1
Figure 1
Mucosal dissection. a Purse‐string occlusion of the rectum (arrow) and b mucosal incision (arrow). Traction on the purse‐string facilitates the mucosal incision
Figure 2
Figure 2
SILS™ Port inserted into anus
Figure 3
Figure 3
Inferior mesenteric artery ligated with a Hem‐o‐lok® clip
Figure 4
Figure 4
SILS™ Port inserted into vagina
See this image and copyright information in PMC

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