Division of Colon and Rectal Surgery, University of South Florida, 1 Tampa General Circle, Suite F-145, Tampa, FL 33602, USA.
Tech Coloproctol. 2013 Feb;17 Suppl 1:S69-73. doi: 10.1007/s10151-012-0934-2. Epub 2013 Jan 24.
Advancements in minimally invasive surgery have both revolutionized laparoscopy and set the stage for the advancement of endoscopic surgery to the forefront of modern medicine. Natural orifice transluminal endoscopic surgery (NOTES) has now become a subject of great interest to surgeons worldwide who wish to reduce the morbidity associated with abdominal operations. However, the application of NOTES to colorectal surgery has thus far been limited due to the complex dissection, anastomosis and specimen extraction typically required when operating on the large bowel. For this reason, laparoscopic-assisted natural orifice surgery has been the means by which most surgeons have begun to incorporate natural orifice surgery into their established practices. Transanal endoscopic surgery, transvaginal-assisted laparoscopy and transrectal specimen extraction are all emerging techniques that may be currently employed, in a hybrid manner, with traditionally accepted laparoscopic operations in order to transition toward less invasive surgery and even pure NOTES. To this end, the vagina appears to be the most practical and widely used site of specimen extraction and adjunct access site for laparoscopic hybrid operations. An accompanying video demonstrates the authors' preferred technique for transvaginal and transrectal specimen extraction.
微创手术的进步不仅彻底改变了腹腔镜技术，而且将内镜手术推向了现代医学的前沿。经自然腔道内镜手术（NOTES）现在成为全世界希望减少腹部手术相关发病率的外科医生关注的焦点。然而，由于在大肠手术中通常需要进行复杂的解剖、吻合和标本提取，因此NOTES 在结直肠手术中的应用受到限制。出于这个原因，腹腔镜辅助自然腔道手术是大多数外科医生开始将自然腔道手术纳入其既定实践的手段。经肛门内镜手术、经阴道辅助腹腔镜手术和经直肠标本提取都是新兴技术，它们可能以混合方式与传统上接受的腹腔镜手术一起使用，以向微创手术甚至纯 NOTES 过渡。为此，阴道似乎是标本提取和腹腔镜混合手术辅助进入部位最实用和广泛使用的部位。一段配套视频展示了作者对经阴道和经直肠标本提取的首选技术。
