title: Trilumenal hybrid-NOS proctocolectomy.
abstract: BACKGROUND
  The authors hypothesized that by combining transumbilical, transvaginal, and transrectal accesses, complex bowel operations, including proctocolectomy with restorative J pouch [corrected] reconstruction, might be possible.
  
  
  RESULTS
  Out of a series of 30 natural orifice surgery (NOS) operations performed at the authors' institution in the past 12 months, proctocolectomy with ileoanal pouch reconstruction was planned for 3 female patients (31 years, BMI = 30; 50 years, BMI = 31; 30 years, BMI = 21) with extensive disease of ulcerative colitis, and they were operated via a 3-lumenal NOS approach. The first 2 patients received a proctocolectomy with a J-pouch formation. A 3-stage procedure was planned for the third patient, and she received a total colectomy. The colonic specimen was retrieved through the anus obviating dilation of the vagina. The J-pouch was prepared through a horizontal 2-cm incision, which later served as the protective loop ileostomy site.
  
  
  CONCLUSIONS
  Trilumenal NOS proctocolectomy is feasible and safe providing a solution to overcome the lack of triangulation using a single-lumen approach.
authors.affiliation: Department for General, Gastrointestinal and Trauma Surgery, Robert-Bosch-Krankenhaus, Stuttgart, Germany. wolfram.lamade@rbk.de
authors.forename: Wolfram
authors.initials: W
authors.lastname: Lamadé
authors.forename: Christoph
authors.initials: C
authors.lastname: Ulmer
authors.forename: Jürgen
authors.initials: J
authors.lastname: Hochberger
authors.forename: Kai
authors.initials: K
authors.lastname: Matthes
authors.forename: Colin
authors.initials: C
authors.lastname: Friedrich
authors.forename: Klaus Peter
authors.initials: KP
authors.lastname: Thon
mesh_terms: D000328:Adult; D003093:Colitis, Ulcerative / Q000601:surgery*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D016737:Proctocolectomy, Restorative / Q000379:methods*