Skip to main content
Erschienen in: Surgical Endoscopy 6/2011

01.06.2011 | New Technology

Laparoscopic sigmoid resection with transrectal specimen extraction has a good short-term outcome

verfasst von: Albert M. Wolthuis, Freddy Penninckx, André D’Hoore

Erschienen in: Surgical Endoscopy | Ausgabe 6/2011

Einloggen, um Zugang zu erhalten

Abstract

Background

Transrectal specimen extraction in laparoscopic sigmoid resection avoids a muscle-split incision for specimen retrieval. A technique for transrectal specimen extraction is described, and the results of a pilot study concerning feasibility are presented.

Methods

All consecutive patients undergoing laparoscopic sigmoid resection with transrectal specimen extraction were included in this observational study. A specimen retrieval pouch was used to facilitate specimen extraction. All preoperative and operative data, postoperative morbidity, and short-term outcome were gathered in a database.

Results

The described technique was used to treat 21 patients. The median age of the patients was 41 years (interquartile range [IQR], 34–66 years). The median body mass index (BMI) was 23 kg/m2 (IQR, 22–26 kg/m2), and 90% of the patients were women. Of the 21 patients, 13 (62%) underwent a resection for endometriosis, 5 (24%) had resection for diverticular disease, and 3 (14%) underwent a tumor resection. The median operating time was 105 min (IQR, 90–110 min), and the median intraoperative blood loss was 10 ml (IQR, 0–20 ml). All the procedures except one (95%) were performed within 2 h. The median length of the extracted specimen was 20 cm (IQR, 13–25 cm). There was one anastomotic leak (5%), treated by emergency laparotomy and creation of a new colorectal anastomosis. None of the patients required a temporary diverting stoma, and no postoperative mortality occurred. The median hospital stay was 6 days (IQR, 5–7 days). All the patients did well during a median follow-up period of 3.6 months, and none reported any anal dysfunction.

Conclusions

Laparoscopic sigmoid resection with transrectal specimen extraction is feasible and has a good short-term outcome.
Literatur
1.
Zurück zum Zitat Akamatsu H, Omori T, Oyama T, Tori M, Ueshima S, Nakahara M, Abe T, Nishida T (2009) Totally laparoscopic sigmoid colectomy: a simple and safe technique for intracorporeal anastomosis. Surg Endosc 23:2605–2609PubMedCrossRef Akamatsu H, Omori T, Oyama T, Tori M, Ueshima S, Nakahara M, Abe T, Nishida T (2009) Totally laparoscopic sigmoid colectomy: a simple and safe technique for intracorporeal anastomosis. Surg Endosc 23:2605–2609PubMedCrossRef
2.
Zurück zum Zitat Cheung HY, Leung AL, Chung CC, Ng DC, Li MK (2009) Endo-laparoscopic colectomy without minilaparotomy for left-sided colonic tumors. World J Surg 33:1287–1291PubMedCrossRef Cheung HY, Leung AL, Chung CC, Ng DC, Li MK (2009) Endo-laparoscopic colectomy without minilaparotomy for left-sided colonic tumors. World J Surg 33:1287–1291PubMedCrossRef
3.
Zurück zum Zitat Whiteford MH, Denk PM, Swanström LL (2007) Feasibility of radical sigmoid colectomy performed as natural orifice translumenal endoscopic surgery (NOTES) using transanal endoscopic microsurgery. Surg Endosc 21:1870–1874PubMedCrossRef Whiteford MH, Denk PM, Swanström LL (2007) Feasibility of radical sigmoid colectomy performed as natural orifice translumenal endoscopic surgery (NOTES) using transanal endoscopic microsurgery. Surg Endosc 21:1870–1874PubMedCrossRef
4.
Zurück zum Zitat Sylla P, Willingham FF, Sohn DK, Gee D, Brugge WR, Rattner DW (2008) NOTES rectosigmoid resection using transanal endoscopic microsurgery (TEM) with transgastric endoscopic assistance: a pilot study in swine. J Gastrointest Surg 12:1717–1723PubMedCrossRef Sylla P, Willingham FF, Sohn DK, Gee D, Brugge WR, Rattner DW (2008) NOTES rectosigmoid resection using transanal endoscopic microsurgery (TEM) with transgastric endoscopic assistance: a pilot study in swine. J Gastrointest Surg 12:1717–1723PubMedCrossRef
5.
Zurück zum Zitat Lacy AM, Delgado S, Rojas OA, Almenara R, Blasi A, Llach J (2008) MA-NOS radical sigmoidectomy: report of a transvaginal resection in the human. Surg Endosc 22:1717–1723PubMedCrossRef Lacy AM, Delgado S, Rojas OA, Almenara R, Blasi A, Llach J (2008) MA-NOS radical sigmoidectomy: report of a transvaginal resection in the human. Surg Endosc 22:1717–1723PubMedCrossRef
6.
Zurück zum Zitat Tan KY, Maeda T, Konishi F (2009) Transanal endoscopic resection of the rectum with high ligation on a swine model: a novel type of natural orifice endoscopic surgery. Multimedia article. Dis Colon Rectum 52:2045–2047PubMedCrossRef Tan KY, Maeda T, Konishi F (2009) Transanal endoscopic resection of the rectum with high ligation on a swine model: a novel type of natural orifice endoscopic surgery. Multimedia article. Dis Colon Rectum 52:2045–2047PubMedCrossRef
7.
Zurück zum Zitat Palanivelu C, Rangarajan M, Jategaonkar PA, Anand NV (2008) An innovative technique for colorectal specimen retrieval: a new era of “natural orifice specimen extraction” (NOSE). Dis Colon Rectum 51:1120–1124PubMedCrossRef Palanivelu C, Rangarajan M, Jategaonkar PA, Anand NV (2008) An innovative technique for colorectal specimen retrieval: a new era of “natural orifice specimen extraction” (NOSE). Dis Colon Rectum 51:1120–1124PubMedCrossRef
8.
Zurück zum Zitat Nezhat F, Nezhat C, Pennington E, Ambroze W Jr (1992) Laparoscopic segmental resection for infiltrating endometriosis of the rectosigmoid colon: a preliminary report. Surg Laparosc Endosc 2:212–216PubMed Nezhat F, Nezhat C, Pennington E, Ambroze W Jr (1992) Laparoscopic segmental resection for infiltrating endometriosis of the rectosigmoid colon: a preliminary report. Surg Laparosc Endosc 2:212–216PubMed
9.
Zurück zum Zitat Franklin ME, Kazantsev GB, Abrego D, Diaz-E JA, Balli J, Glass JL (2000) Laparoscopic surgery for stage III colon cancer: long-term follow-up. Surg Endosc 14:612–616PubMedCrossRef Franklin ME, Kazantsev GB, Abrego D, Diaz-E JA, Balli J, Glass JL (2000) Laparoscopic surgery for stage III colon cancer: long-term follow-up. Surg Endosc 14:612–616PubMedCrossRef
10.
Zurück zum Zitat Franklin ME Jr, Diaz-E JA (2000) Laparoscopic left hemicolectomy with transanal extraction of the specimen. In: Ballantyne GH (ed) Atlas of laparoscopic surgery. WB Saunders Co, Philadelphia, pp 386–404 Franklin ME Jr, Diaz-E JA (2000) Laparoscopic left hemicolectomy with transanal extraction of the specimen. In: Ballantyne GH (ed) Atlas of laparoscopic surgery. WB Saunders Co, Philadelphia, pp 386–404
11.
Zurück zum Zitat Inoue Y, Noro H, Komoda H, Kimura T, Mizushima T, Taniguchi E, Yumiba T, Itoh T, Ohashi S, Matsuda H (2002) Completely laparoscopic total colectomy for chronic constipation: report of a case. Surg Today 32:551–554PubMedCrossRef Inoue Y, Noro H, Komoda H, Kimura T, Mizushima T, Taniguchi E, Yumiba T, Itoh T, Ohashi S, Matsuda H (2002) Completely laparoscopic total colectomy for chronic constipation: report of a case. Surg Today 32:551–554PubMedCrossRef
12.
Zurück zum Zitat Knol J, D’Hondt M, Dozois EJ, Vanden Boer J, Malisse P (2009) Laparoscopic-assisted sigmoidectomy with transanal specimen extraction: a bridge to NOTES? Tech Coloproctol 13:65–68PubMedCrossRef Knol J, D’Hondt M, Dozois EJ, Vanden Boer J, Malisse P (2009) Laparoscopic-assisted sigmoidectomy with transanal specimen extraction: a bridge to NOTES? Tech Coloproctol 13:65–68PubMedCrossRef
13.
Zurück zum Zitat Choi GS, Park IJ, Kang BM, Lim KH, Jun SH (2009) A novel approach of robotic-assisted anterior resection with transanal or transvaginal retrieval of the specimen for colorectal cancer. Surg Endosc 23:2831–2835CrossRef Choi GS, Park IJ, Kang BM, Lim KH, Jun SH (2009) A novel approach of robotic-assisted anterior resection with transanal or transvaginal retrieval of the specimen for colorectal cancer. Surg Endosc 23:2831–2835CrossRef
14.
Zurück zum Zitat Bretagnol F, Rullier E, Couderc P, Rullier A, Saric J (2003) Technical and oncological feasibility of laparoscopic total mesorectal excision with pouch coloanal anastomosis for rectal cancer. Colorectal Dis 5:451–453PubMedCrossRef Bretagnol F, Rullier E, Couderc P, Rullier A, Saric J (2003) Technical and oncological feasibility of laparoscopic total mesorectal excision with pouch coloanal anastomosis for rectal cancer. Colorectal Dis 5:451–453PubMedCrossRef
15.
Zurück zum Zitat Marks J, Mizrahi B, Dalane S, Nweze I, Marks G (2010) Laparoscopic transanal abdominal transanal resection with sphincter preservation for rectal cancer in the distal 3 cm of the rectum after neoadjuvant therapy. Surg Endosc 24:2700–2707PubMedCrossRef Marks J, Mizrahi B, Dalane S, Nweze I, Marks G (2010) Laparoscopic transanal abdominal transanal resection with sphincter preservation for rectal cancer in the distal 3 cm of the rectum after neoadjuvant therapy. Surg Endosc 24:2700–2707PubMedCrossRef
16.
Zurück zum Zitat Tsin DA (2001) Culdolaparoscopy: a preliminary report. JSLS 5:69–71PubMed Tsin DA (2001) Culdolaparoscopy: a preliminary report. JSLS 5:69–71PubMed
17.
Zurück zum Zitat Tsin DA, Colombero LT, Mahmood D, Padouvas J, Manolas P (2001) Operative culdolaparoscopy: a novel approach combining operative culdoscopy with minilaparoscopy. J Am Assoc Gynecol Laparosc 8:438–441PubMedCrossRef Tsin DA, Colombero LT, Mahmood D, Padouvas J, Manolas P (2001) Operative culdolaparoscopy: a novel approach combining operative culdoscopy with minilaparoscopy. J Am Assoc Gynecol Laparosc 8:438–441PubMedCrossRef
18.
Zurück zum Zitat Ghezzi F, Raio L, Mueller MD, Gyr T, Buttarelli M, Franchi M (2002) Vaginal extraction of pelvic masses following operative laparoscopy. Surg Endosc 1:1691–1696CrossRef Ghezzi F, Raio L, Mueller MD, Gyr T, Buttarelli M, Franchi M (2002) Vaginal extraction of pelvic masses following operative laparoscopy. Surg Endosc 1:1691–1696CrossRef
19.
Zurück zum Zitat Redwine DB, Koning M, Sharpe DR (1996) Laparoscopically assisted transvaginal segmental resection of the rectosigmoid colon for endometriosis. Fertil Steril 65:193–197PubMed Redwine DB, Koning M, Sharpe DR (1996) Laparoscopically assisted transvaginal segmental resection of the rectosigmoid colon for endometriosis. Fertil Steril 65:193–197PubMed
20.
Zurück zum Zitat Jerby BL, Kessler H, Falcone T, Milsom JW (1999) Laparoscopic management of colorectal endometriosis. Surg Endosc 13:1125–1128PubMedCrossRef Jerby BL, Kessler H, Falcone T, Milsom JW (1999) Laparoscopic management of colorectal endometriosis. Surg Endosc 13:1125–1128PubMedCrossRef
21.
Zurück zum Zitat Abrao MS, Sagae UE, Gonzales M, Podgaec S, Dias JA (2005) Treatment of rectosigmoid endometriosis by laparoscopically assisted vaginal rectosigmoidectomy. Int J Gynaecol Obstet 91:27–31PubMedCrossRef Abrao MS, Sagae UE, Gonzales M, Podgaec S, Dias JA (2005) Treatment of rectosigmoid endometriosis by laparoscopically assisted vaginal rectosigmoidectomy. Int J Gynaecol Obstet 91:27–31PubMedCrossRef
22.
Zurück zum Zitat Boni L, Tenconi S, Beretta P, Cromi A, Dionigi G, Rovera F, Dionigi R, Ghezzi F (2007) Laparoscopic colorectal resections with transvaginal specimen extraction for severe endometriosis. Surg Oncol 16:S157–S160PubMedCrossRef Boni L, Tenconi S, Beretta P, Cromi A, Dionigi G, Rovera F, Dionigi R, Ghezzi F (2007) Laparoscopic colorectal resections with transvaginal specimen extraction for severe endometriosis. Surg Oncol 16:S157–S160PubMedCrossRef
23.
Zurück zum Zitat Ghezzi F, Cromi A, Ciravolo G, Rampinelli F, Braga M, Boni L (2008) A new laparoscopic-transvaginal technique for rectosigmoid resection in patients with endometriosis. Fertil Steril 90:1964–1968PubMedCrossRef Ghezzi F, Cromi A, Ciravolo G, Rampinelli F, Braga M, Boni L (2008) A new laparoscopic-transvaginal technique for rectosigmoid resection in patients with endometriosis. Fertil Steril 90:1964–1968PubMedCrossRef
Metadaten
Titel
Laparoscopic sigmoid resection with transrectal specimen extraction has a good short-term outcome
verfasst von
Albert M. Wolthuis
Freddy Penninckx
André D’Hoore
Publikationsdatum
01.06.2011
Verlag
Springer-Verlag
Erschienen in
Surgical Endoscopy / Ausgabe 6/2011
Print ISSN: 0930-2794
Elektronische ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-010-1472-5

Weitere Artikel der Ausgabe 6/2011

Surgical Endoscopy 6/2011 Zur Ausgabe

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

S3-Leitlinie „Diagnostik und Therapie des Karpaltunnelsyndroms“

Karpaltunnelsyndrom BDC Leitlinien Webinare
CME: 2 Punkte

Das Karpaltunnelsyndrom ist die häufigste Kompressionsneuropathie peripherer Nerven. Obwohl die Anamnese mit dem nächtlichen Einschlafen der Hand (Brachialgia parästhetica nocturna) sehr typisch ist, ist eine klinisch-neurologische Untersuchung und Elektroneurografie in manchen Fällen auch eine Neurosonografie erforderlich. Im Anfangsstadium sind konservative Maßnahmen (Handgelenksschiene, Ergotherapie) empfehlenswert. Bei nicht Ansprechen der konservativen Therapie oder Auftreten von neurologischen Ausfällen ist eine Dekompression des N. medianus am Karpaltunnel indiziert.

Prof. Dr. med. Gregor Antoniadis
Berufsverband der Deutschen Chirurgie e.V.

S2e-Leitlinie „Distale Radiusfraktur“

Radiusfraktur BDC Leitlinien Webinare
CME: 2 Punkte

Das Webinar beschäftigt sich mit Fragen und Antworten zu Diagnostik und Klassifikation sowie Möglichkeiten des Ausschlusses von Zusatzverletzungen. Die Referenten erläutern, welche Frakturen konservativ behandelt werden können und wie. Das Webinar beantwortet die Frage nach aktuellen operativen Therapiekonzepten: Welcher Zugang, welches Osteosynthesematerial? Auf was muss bei der Nachbehandlung der distalen Radiusfraktur geachtet werden?

PD Dr. med. Oliver Pieske
Dr. med. Benjamin Meyknecht
Berufsverband der Deutschen Chirurgie e.V.

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“

Appendizitis BDC Leitlinien Webinare
CME: 2 Punkte

Inhalte des Webinars zur S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“ sind die Darstellung des Projektes und des Erstellungswegs zur S1-Leitlinie, die Erläuterung der klinischen Relevanz der Klassifikation EAES 2015, die wissenschaftliche Begründung der wichtigsten Empfehlungen und die Darstellung stadiengerechter Therapieoptionen.

Dr. med. Mihailo Andric
Berufsverband der Deutschen Chirurgie e.V.