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An experimental study in six fresh human cadavers using a novel approach to avoid abdominal wall incisions in total colectomy: totally transanal laparoendoscopic single-site pull-through colectomy with J-pouch creation

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Abstract

Background

The use of transanal laparoscopic access to completely avoid abdominal wall incisions represents the most current evolution in minimally invasive surgery. The combination of single-site surgery and natural orifice transluminal endoscopic surgery (NOTES™) can be used for totally transanal laparoendoscopic pull-through colectomy with J-pouch creation (TLPC-J). The aim of the present study was to provide evidence for the feasibility of TLPC-J in adult human cadavers.

Methods

TLPC-J was performed in six fresh adult human cadavers. The procedure involved endorectal submucosal dissection from 1 cm above the dentate line to a point above the peritoneal reflection, where the rectal muscle was divided circumferentially. The edge of the mucosal cuff was closed distally in order to prevent fecal contamination and the endorectal tube was placed back into the abdomen. A Triport+™ or QuadPort+™ system was introduced transanally, and it served as a multiport device (MD). Resection of the entire colon, mobilization of the distal ileal segment, and extracorporeal suture of the ileal J-loop were performed via the transanal approach. The J-pouch was created using Endo GIA™. After removal of the MD, the J-pouch was sutured to the rectal wall.

Results

TLPC-J was performed in all cadavers, with a mean operation duration of 236 ± 22 min. Conversion to either transabdominal laparoscopy or laparotomy was not required in any of the cadavers. No bowel perforation or damage to other organs was observed. The use of a curved endoscope greatly facilitated visualization during transanal laparoscopic dissection for partial and total colectomy, making the procedure feasible. All specimens were retrieved through the anus, eliminating the need for additional transabdominal incisions.

Conclusions

TLPC-J was technically feasible in adult human cadavers, and abdominal wall incisions were not required. However, clinical studies are needed to determine its feasibility in living adults.

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References

  1. Fuchs KH, Breithaupt W, Varga G et al (2013) Transanal hybrid colon resection: from laparoscopy to NOTES. Surg Endosc 27:746–752

    Article  PubMed  Google Scholar 

  2. Fuchs KH, Meining A, von Renteln D (2013) Euro-NOTES status paper: from the concept to clinical practice. Surg Endosc 27:1456–1467

    Article  CAS  PubMed  Google Scholar 

  3. Vahdad MR, Foroutan A, Najafi SM et al (2013) Totally transanal LESS pull-through colectomy: a novel approach for avoiding abdominal wall incision in children with long-segment intestinal aganglionosis. J Laparoendosc Adv Surg Tech A 23:276–280

    Article  PubMed  Google Scholar 

  4. Martin-Perez B, Andrade-Ribeiro GD, Hunter L et al (2014) A systematic review of transanal minimally invasive surgery (TAMIS) from 2010 to 2013. Tech Coloproctol 18:775–788

    Article  CAS  PubMed  Google Scholar 

  5. Mozafar M, Shateri K, Tabatabaey A et al (2014) Familial adenomatous polyposis: ileo-anal pouch versus ileo-rectal anastomosis. Gastroenterol Hepatol Bed Bench 7:206–210

    PubMed  PubMed Central  Google Scholar 

  6. Tasende MM, Delgado S, Jimenez M et al (2015) Minimal invasive surgery: NOSE and NOTES in ulcerative colitis. Surg Endosc. doi:10.1007/s00464-015-4087-z

    PubMed  Google Scholar 

  7. Trigui A, Frikha F, Rejab H et al (2014) Ileal pouch-anal anastomosis: points of controversy. J Visc Surg 151:281–288

    Article  CAS  PubMed  Google Scholar 

  8. Muensterer OJ, Chong A, Hansen EN et al (2010) Single-incision laparoscopic endorectal pull-through (SILEP) for hirschsprung disease. J Gastrointest Surg 14:1950–1954

    Article  PubMed  Google Scholar 

  9. Bemelman WA (2010) Laparoscopic ileoanal pouch surgery. Br J Surg 97:2–3

    Article  CAS  PubMed  Google Scholar 

  10. Sylla P (2010) Current experience and future directions of completely NOTES colorectal resection. World J Gastrointest Surg 2:193–198

    Article  PubMed  PubMed Central  Google Scholar 

  11. Fajardo AD, Hunt SR, Fleshman JW et al (2010) Video. Transanal single-port low anterior resection in a cadaver model. Surg Endosc 24:1765

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

We thank Mrs. Charlotte Schmitz (CATSNFROGS Medical Illustrations) for illustrating the steps of the surgical procedure. Additionally, we thank Editage (www.editage.com) for English language editing.

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Authors and Affiliations

  1. Department of Pediatric Surgery and Pediatric Urology, Kliniken der Stadt Köln gGmbH, Kinderkrankenhaus Amsterdamer Strasse 59, 50735, Cologne, Germany

    M. Reza Vahdad, Alexander Semaan, Tobias Klein & Thomas Boemers

  2. Department of Pediatric Surgery, University Hospital Cologne, Kerpenerstr. 62, 50937, Cologne, Germany

    Grigore Cernaianu

  3. Olympus Surgical Technologies Europe, Kuehnstraße 61, 22045, Hamburg, Germany

    Samuel Faran

  4. White Plains Hospital, 210 Westchester Avenue, White Plains, NY, 10604, USA

    Harry Zemon

  5. Department of Pediatric Surgery, Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, 7141995377, Iran

    Hamid Reza Foroutan

Authors
  1. M. Reza Vahdad
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  2. Grigore Cernaianu
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  3. Alexander Semaan
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  4. Tobias Klein
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  5. Samuel Faran
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  6. Harry Zemon
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  7. Thomas Boemers
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  8. Hamid Reza Foroutan
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Corresponding author

Correspondence to M. Reza Vahdad.

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Disclosures

M. Reza Vahdad and Harry Zemon are consultants for Olympus Surgical Technologies. Samuel Faran is an employee of Olympus Surgical Technologies. Grigore Cernaianu, Alexander Semaan, Tobias Klein, Thomas Boemers, and Hamid Reza Foroutan have no conflicts of interest or financial ties to disclose.

Additional information

Presented at the SAGES 2015 Annual Meeting, April 15–18, 2015, Nashville, Tennessee.

Electronic supplementary material

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Transanal laparoscopic bowel dissection between the rectum and the left colonic flexure (WMV 32825 kb)

Transanal laparoscopic bowel resection between the transverse colon and the ascending colon, and transanal extraction of the resected bowel (WMV 21794 kb)

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Vahdad, M.R., Cernaianu, G., Semaan, A. et al. An experimental study in six fresh human cadavers using a novel approach to avoid abdominal wall incisions in total colectomy: totally transanal laparoendoscopic single-site pull-through colectomy with J-pouch creation. Surg Endosc 30, 3107–3113 (2016). https://doi.org/10.1007/s00464-015-4555-5

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