The surgical technique and some preliminary results were presented at the following meetings: the 18th International Congress of the European Association for Endoscopic Surgery, Geneva, 6/2010 (‘Session: Best 6 videos’); Le 112ème Congrès de l’Association Française de Chirurgie, Paris, 10/2010.
Transrectal specimen extraction after laparoscopic left colectomy: a case-matched study
Article first published online: 27 FEB 2013
© 2012 The Authors Colorectal Disease © 2012 The Association of Coloproctology of Great Britain and Ireland
Volume 15, Issue 3, pages 347–353, March 2013
How to Cite
Christoforidis, D., Clerc, D. and Demartines, N. (2013), Transrectal specimen extraction after laparoscopic left colectomy: a case-matched study. Colorectal Disease, 15: 347–353. doi: 10.1111/codi.12006
- Issue published online: 27 FEB 2013
- Article first published online: 27 FEB 2013
- Accepted manuscript online: 3 OCT 2012 01:33AM EST
- Received 15 March 2012; accepted 16 June 2012; Accepted Article online 3 October 2012
- NOSE (natural orifice specimen extraction);
Aim Avoiding ‘mini-laparotomy’ to extract a colectomy specimen may decrease wound complications and further improve recovery after laparoscopic surgery. The aim of this study was to develop a new technique for transrectal specimen extraction (TRSE) and to compare it with conventional laparoscopy (CL) for left sided colectomy.
Method Eleven patients with benign disease requiring either sigmoid or left colon resection underwent TRSE. The unfired circular stapler was inserted transanally and used as a guide to suture-close the recto-sigmoid junction laparoscopically and as a handle to pull the sutured sigmoid through the opened rectum inside a laparoscopic camera bag. The anvil was inserted into the lumen of the intussuscepted sigmoid and pushed to the level of the anastomosis. The anastomosis was fashioned end-to-end in the first patients and side-to-end in the following patients to improve safety. Intra-operative and postoperative outcomes of patients undergoing TRSE were compared with those of a group of 20 patients undergoing CL, who were matched for type of resection, body mass index and age.
Results The procedure was successful in all but the first patient who was converted to conventional laparoscopic colectomy without any additional morbidity. Two patients in the end-to-end anastomosis group, but none in the side-to-end group, developed peri-anastomotic sepsis. Compared with CL, patients undergoing TRSE did not show any significant differences in operative time, recovery or morbidity.
Conclusion Transrectal specimen extraction after left colectomy using the circular stapler technique is feasible. A side-to-end anastomosis appears safer than an end-to-end anastomosis. Further studies are needed to explore the potential advantages of this procedure over CL.