Zorron Ricardo, Phillips Henrique Neubarth, Coelho Djalma, Flach Luciana, Lemos Fabiano Batista, Vassallo Ricardo Cortez
University Hospital Teresopolis HCTCO FESO, Rio de Janeiro, Brazil.
Surg Innov. 2012 Mar;19(1):11-9. doi: 10.1177/1553350611409956. Epub 2011 Jul 7.
Clinical natural orifice surgery has been applied for abdominal surgery in recent years, mostly by vaginal and oral access. The study describes preliminary successful human applications of transcolonic natural orifice transluminal endoscopic surgery (NOTES), using a new transrectal total mesorectal excision procedure for rectal cancer.
Institutional review board approval was obtained for the study. In 2 patients with rectal adenocarcinoma, total mesorectal resection and rectosigmoidectomy with lymphadenectomy was performed using a low NOTES transcolonic access. "Down-to-up" mesorectal dissection was achieved either using a flexible scope or a transrectal single port device. The specimens were extracted transanally, and transorificial low anastomosis was performed.
Operative time was 350 and 360 minutes, respectively; no complications occurred and patients were discharged after 6 days.
Successful human reports on transcolonic NOTES suggest potential applications. The treatment of colorectal diseases through transorificial single port or flexible perirectal NOTES access are promising new approaches besides current methods to improve patient care.
近年来，临床自然腔道手术已应用于腹部手术，主要通过阴道和口腔入路。本研究描述了经结肠自然腔道内镜手术（NOTES）在人体上初步成功的应用，采用一种新的经直肠全直肠系膜切除术治疗直肠癌。
本研究获得了机构审查委员会的批准。对2例直肠腺癌患者，采用低位经结肠NOTES入路进行全直肠系膜切除及直肠乙状结肠切除术并清扫淋巴结。使用软性内镜或经直肠单孔装置进行“由下向上”的直肠系膜分离。标本经肛门取出，并进行经口低位吻合。
手术时间分别为350分钟和360分钟；未发生并发症，患者术后6天出院。
经结肠NOTES在人体上的成功报道提示了其潜在的应用价值。除了目前的方法外，通过经口单孔或软性经直肠NOTES入路治疗结直肠疾病是改善患者护理的有前景的新方法。
