Abstract
Objective To explore the feasibility, safety and short-term effects of the reverse puncture technique for total laparoscopic colorectal resection with natural orifice specimen extraction surgery (NOSES). Materials and Methods The clinical data of 28 patients undergoing total laparoscopic anterior resection with NOSE from July 2016 to July 2019 were retrospectively analysed. The operation was performed following the principle of total mesorectal excision. The reverse puncture technique was used to put the anvil into the proximal sigmoid colon. Then, intra-abdominal anastomosis of the proximal colon and distal rectum was carried out, and the short-term efficacy was evaluated. Results All 28 patients successfully underwent surgery, and the average operative time was 186 (160~220) min. The average time of anvil placement was 15 (12~18) min, the blood loss volume ranged from 60 to 150 ml, and the average length of hospital stay was 9.2 (7-11) d. All of the distal resection margins were confirmed to be negative by the pathological results. No surgery-associated complications, such as anastomosis stricture, leakage, or bleeding, were observed, and no local recurrence or metastasis occurred after 6 months of follow-up. Conclusion Reverse puncture for total laparoscopic colorectal resection with NOSE can avoid purse-string sutures under laparoscopy and avoid the auxiliary incision at the abdominal wall, which minimizes pain after operation. This approach is safe and feasible with a shortened hospital stay and rapid recovery, which results in good short-term clinical outcomes.
Transanal colorectal resection using natural orifice translumenal endoscopic surgery (NOTES)
