Cheung Hester Y S, Leung Alex L H, Chung C C, Ng Dennis C K, Li Michael K W
Department of Surgery, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong, SAR China.
World J Surg. 2009 Jun;33(6):1287-91. doi: 10.1007/s00268-009-0006-6.
In performing "traditional" laparoscopic colectomy for left-sided colonic tumors, specimen retrieval necessitates a mini-laparotomy which often is the cause of postoperative pain, wound infection, and other pain-related complications. Here we describe a new technique of endo-laparoscopic anterior resection without mini-laparotomy, where specimen retrieval and colorectal anastomosis can be safely achieved with the use of the transanal endoscopic operation (TEO) device set-up.
This hybrid natural orifice transluminal endoscopic surgery (NOTES) technique involves insertion of the TEO device in the lower rectum and luminal extraction of the specimen via the device. The technique is applicable to patients with small tumors (4 cm or less) in the left-sided colon or upper rectum, where transanal construction of a stapled colorectal anastomosis is intended.
The technique was attempted in ten patients (male:female 4:6) with median age of 66 years (range: 55-81 years). Five patients suffered from rectosigmoid tumors, whereas four patients had lesions in the sigmoid colon and one had a lesion in the descending colon. The median operating time was 127.5 min (range: 105-170 min) and the median blood loss was 20 ml (range: 20-50 ml). The median hospital stay was 7 days (range: 4-18 days), while the median maximum pain score (visual analog score) was 2 (range: 2-3) during in-hospital stay in this small series.
Our preliminary experience indicates this new technique of endo-laparoscopic colectomy is feasible for selected patients with left-sided colonic tumors. Complications related to mini-laparotomy can be abolished entirely with this hybrid approach.
在对左侧结肠肿瘤进行“传统”腹腔镜结肠切除术时，标本取出需要进行小切口剖腹手术，这往往是术后疼痛、伤口感染及其他与疼痛相关并发症的原因。在此，我们描述一种无需小切口剖腹手术的内镜下腹腔镜前切除术新技术，该技术使用经肛门内镜手术（TEO）设备装置可安全实现标本取出和结直肠吻合。
这种混合式经自然腔道内镜手术（NOTES）技术包括将TEO设备插入直肠下段，并通过该设备经腔道取出标本。该技术适用于左侧结肠或直肠上段有小肿瘤（4厘米或更小）且打算经肛门进行吻合器结直肠吻合的患者。
对10例患者（男∶女为4∶6）尝试了该技术，患者中位年龄为66岁（范围：55 - 81岁）。5例患者患有直肠乙状结肠肿瘤，4例患者病变位于乙状结肠，1例患者病变位于降结肠。中位手术时间为127.5分钟（范围：105 - 170分钟），中位失血量为20毫升（范围：20 - 50毫升）。中位住院时间为7天（范围：4 - 18天），而在这个小系列中，住院期间的中位最大疼痛评分（视觉模拟评分）为2（范围：2 - 3）。
我们的初步经验表明，这种内镜下腹腔镜结肠切除术新技术对选定的左侧结肠肿瘤患者是可行的。这种混合方法可完全消除与小切口剖腹手术相关的并发症。
