Cheung T P P, Cheung H Y S, Ng L W C, Chung C C C, Li M K W
Department of Surgery, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China.
Asian J Endosc Surg. 2012 Feb;5(1):46-9. doi: 10.1111/j.1758-5910.2011.00106.x.
Given the limitation of surgical access and instrumentation, pure NOTES technique currently appears challenging for colorectal surgery. As such, we would like to determine the technical feasibility and clinical results of hybrid NOTES right hemicolectomy with transrectal extraction of specimen.
After the right-sided colon was fully mobilized and vessels ligated, bowel resection and intracorporeal side-to-side ileocolic anastomosis were performed with endostaplers. The Transanal Endoscopic Operations device was inserted transanally. The resected specimen was removed via the Transanal Endoscopic Operations device through an enterotomy made over the anterior wall of the upper rectum.
The operation was performed on a 42-year-old woman and lasted 120 minutes; blood loss was 30 mL. The patient had an uneventful recovery and was discharged on postoperative day 5. The median pain score was 2 (range, 2-3). Our preliminary experience shows that hybrid NOTES right hemicolectomy is safe and feasible. The technique eliminates the need for mini-laparotomy in patients undergoing laparoscopic right hemicolectomy, and it offers promise in this era of minimally invasive surgery.
鉴于手术入路和器械的局限性，目前单纯经自然腔道内镜手术（NOTES）技术应用于结直肠手术似乎具有挑战性。因此，我们旨在确定经直肠取出标本的NOTES杂交右半结肠切除术的技术可行性和临床效果。
右侧结肠充分游离并结扎血管后，使用腔内吻合器进行肠切除及体内端侧回结肠吻合。经肛门插入经肛门内镜手术装置。通过在直肠上段前壁做的肠切开术，经该装置取出切除标本。
该手术在一名42岁女性患者身上实施，持续120分钟，失血30毫升。患者恢复顺利，术后第5天出院。疼痛评分中位数为2分（范围2 - 3分）。我们的初步经验表明，NOTES杂交右半结肠切除术安全可行。该技术避免了腹腔镜右半结肠切除术患者进行小切口开腹手术的需要，在这个微创手术时代具有前景。
