Song Zi-Jia, Shi Yi-Qing, Jiang Yi-Mei, Liu Kun, Li You, Wang Chang-Gang, Zhao Ren
Department of General Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 201801, China.
World J Clin Cases. 2021 Mar 6;9(7):1714-1719. doi: 10.12998/wjcc.v9.i7.1714.
Pure natural orifice transluminal endoscopic surgery (NOTES) for colorectal cancer is a complex procedure and rarely used in clinical practice because of the ethical concerns and technical challenges, including loss of triangulation, in-line orientation, and instrument collision. Transvaginal (v) NOTES, however, can overcome these technical challenges. We report a case of pure vNOTES right hemicolectomy for colon cancer, attached with surgical video.
A 65-year-old woman with a 2-year history of intermittent diarrhea was diagnosed with ascending colon adenocarcinoma by colonoscopy and biopsy. Pure vNOTES right hemicolectomy was performed with complete mesocolic excision by well-experienced surgeons. The operative time was 200 min and the estimated blood loss was 30 mL. No intraoperative or postoperative complications occurred within 30 d after the surgery. The visual analog scale pain score on postoperative day 1 was 1 and dropped to 0 on postoperative days 2 and 3. The patient was discharged at postoperative day 6. The pathologic specimen had sufficient clear resection margins and 14 negative harvested lymph nodes.
vNOTES right hemicolectomy, performed by well-experienced surgeons, overcomes the technical challenges of pure NOTES and may be feasible for colon cancer.
用于结直肠癌的纯自然腔道内镜手术（NOTES）是一种复杂的手术，由于伦理问题和技术挑战，包括三角定位丧失、直线定向和器械碰撞，在临床实践中很少使用。然而，经阴道（v）NOTES可以克服这些技术挑战。我们报告一例经阴道纯NOTES右半结肠切除术治疗结肠癌的病例，并附上手术视频。
一名65岁女性，有2年间歇性腹泻病史，经结肠镜检查和活检诊断为升结肠腺癌。经验丰富的外科医生进行了经阴道纯NOTES右半结肠切除术，并完整切除结肠系膜。手术时间为200分钟，估计失血量为30毫升。术后30天内未发生术中或术后并发症。术后第1天视觉模拟评分疼痛评分为1分，术后第2天和第3天降至0分。患者于术后第6天出院。病理标本切缘足够清晰，14枚清扫淋巴结阴性。
由经验丰富的外科医生进行的经阴道NOTES右半结肠切除术克服了纯NOTES的技术挑战，可能适用于结肠癌。
