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  • Title: Laparoscopic total colectomy with transvaginal extraction of the colon and ileorectal anastomosis.
    Author: Awad Z.
    Journal: Ann Surg Oncol; 2014 Sep; 21(9):3029. PubMed ID: 24743907.
    Abstract:
    BACKGROUND: The abdominal incision extraction site continues to be major source of morbidity after laparoscopic colectomy: mainly, incisional pain, wound infection, and incisional hernia. Also, in selected cases, it may delay initiating chemotherapy. METHODS: The video describes the technique of performing laparoscopic total colectomy, transvaginal removal of the entire colon, and intracorporeal ileorectal anastomosis in a 40-year-old woman with a sigmoid cancer and multiple endoscopically unresectable polyps throughout the colon. Computed tomography scan showed 2 liver lesions with carcinoembryonic antigen 138. Familial adenomatous polyposis gene analysis was negative. Six trocars (one 12 mm and five 5 mm) were used. The whole colon was removed through the transvaginal route. The anvil was introduced through the vagina, and circular stapled ileorectal anastomosis was done. RESULTS: There were no intraoperative complications. The operating time was 210 min. Blood loss was 20 mL. The patient was discharged home on postoperative day 2. Final pathology was T3N1bM1, and 2 of 23 lymph nodes were metastatic. All polyps were tubulovillous. She was commenced on chemotherapy 2 weeks after surgery. At 6-month follow-up, the patient was doing well, had no abdominal pain, and had no vaginal discharge or dyspareunia. CONCLUSIONS: Natural orifice specimen extraction (NOSE) surgery can be added to the armamentarium of surgeons performing laparoscopic colon surgery. This technique may provide both an attractive way to reduce abdominal incision-related morbidity and a bridge to pure natural orifice transluminal endoscopic surgery (NOTES) colon surgery. Large-number patient data with long-term follow-up is needed.
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