title: Natural orifice specimen extraction for avoiding laparotomy in laparoscopic left colon resections: a new approach using the McCartney tube and the tilt top anvil technique.
abstract: BACKGROUND
  Classical laparoscopic left colon resection requires a minilaparotomy. This wound can cause pain and morbidity. We describe our technique to avoid minilaparotomy by natural orifice specimen extraction.
  
  
  METHODS
  A four-port standard laparoscopic dissection for diverticular disease and small tumors of the left colon was performed. A silicon McCartney tube was transanally inserted into the rectum to remove the specimen and to pass the anvil of the circular stapler into the abdominal cavity. The head of the anvil was mechanically pretilted to facilitate introduction into the proximal colon. Double-stapled anastomosis was performed in the usual manner.
  
  
  RESULTS
  Eight patients with diverticular disease or small tumors were operated. There were no adverse events. Operating time ranged between 95 and 180 minutes. For malignancies, tissue margins and lymphadenectomy were oncologically adequate. Four week follow-up was uneventful.
  
  
  CONCLUSIONS
  The described natural orifice specimen extraction technique has the potential to avoid incision-related morbidity of the minilaparotomy in laparoscopic left colon resections.
authors.affiliation: Department of General Surgery, Clinic Gummersbach, Academic Hospital, University of Cologne, Gummersbach, Germany. stefansaad@aol.com
authors.forename: Stefan
authors.initials: S
authors.lastname: Saad
authors.forename: Hisahiro
authors.initials: H
authors.lastname: Hosogi
mesh_terms: D000714:Anastomosis, Surgical / Q000379:methods; D003106:Colon / Q000601:surgery*; D003110:Colonic Neoplasms / Q000150:complications / Q000601:surgery; D004239:Diverticulitis, Colonic / Q000150:complications / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods*; D007813:Laparotomy; D008297:Male; D010149:Postoperative Pain / Q000209:etiology; D013537:Sutures; D016896:Treatment Outcome