Burghardt J, Federlein M, Müller V, Benhidjeb T, Elling D, Gellert K
Evangelisches Freikirchliches Krankenhaus Rüdersdorf.
Zentralbl Chir. 2008 Dec;133(6):574-6. doi: 10.1055/s-2008-1076992. Epub 2008 Dec 17.
Laparoscopic surgery has dramatically changed abdominal surgery by reducing the risk of wound infections, incisional hernias and adhesions. The surgical concept using natural orifices (NOS) may be even less traumatic and so less invasive.
This operation was performed in a 66-year-old woman with an adenoma in the ascending colon. Through a 5 mm incision at the umbilicus a pneumoperitoneum was created and a trocar inserted. For the operation a 12 mm trocar and a curved grasper have been inserted in the posterior fornix of the vagina. Because of adhesions an additional 5 mm trocar was necessary. Through this incision the laparoscopic right hemicolectomy with an intracorporal anastomosis was performed.
The histology showed an adenoma with 21 lymph nodes. The removal of the specimen through the vagina was without any difficulties. The postoperative course was regular.
This operation is to our knowledge the first right hemicolectomy as a NOS/NOTES-operation in a human patient. It shows that with rigid instruments even complex procedures through natural orifices are feasible.
腹腔镜手术通过降低伤口感染、切口疝和粘连的风险，极大地改变了腹部手术。使用自然腔道（NOS）的手术理念可能创伤更小，因此侵入性更小。
该手术在一名66岁升结肠腺瘤女性患者身上进行。通过脐部一个5毫米的切口建立气腹并插入套管针。手术时，在阴道后穹隆插入一个12毫米的套管针和一个弯形抓钳。由于粘连，还需要额外插入一个5毫米的套管针。通过这个切口进行了腹腔镜右半结肠切除术并进行了体内吻合。
组织学检查显示为一个伴有21个淋巴结的腺瘤。通过阴道取出标本没有任何困难。术后病程正常。
据我们所知，该手术是人类患者首例作为自然腔道手术/经自然腔道内镜手术（NOS/NOTES）的右半结肠切除术。它表明，使用硬质器械，即使是通过自然腔道进行的复杂手术也是可行的。
