title: Totally laparoscopic sigmoid colectomy with transanal specimen extraction.
abstract: BACKGROUND
  Conventional techniques for laparoscopic-assisted colectomy (LAC) require abdominal minilaparotomy for extraction of the specimen. Abdominal wound complications often increase the invasiveness of LAC. To decrease the incidence of wound complications, natural orifice specimen extraction (NOSE) has been reported. However, only a few devices that allow smooth extraction and reduced intracorporeal contamination have been reported previously. We performed totally laparoscopic sigmoid colectomy using transanal specimen extraction (TASE) and the Alexis(®) wound retractor (Applied Medical, Rancho Santa Margarita, CA, USA). We document this simple and safe technique and its short-term results.
  
  
  METHODS
  We prospectively collected data on 18 patients who underwent totally laparoscopic sigmoid colectomy with TASE from April 2009 to July 2010. Lymph node dissection and transection of proximal and distal colon were performed in conventional manner. The transected rectal stump was opened transversely, and a long Babcock grasper was inserted transanally through the opened rectal stump. One of a pair of Alexis rings was held and pulled out of the anus. The other ring was placed in the opened rectal stump. The specimen was then extracted transanally through the Alexis. After the Alexis had been removed, the rectal opening was reclosed with a linear stapler. End-to-end colorectal anastomosis was then performed using the double-stapling technique.
  
  
  RESULTS
  Transanal extraction was achieved in 17 cases. We switched to conventional LAC in a case involving a bulky specimen. In 16 cases not including the combined cholecystectomy case, mean operation time was 241 min. One case was complicated by anastomotic leakage and wound infection, while another had enterocolitis. Median hospital stay was 6 days. All patients remained disease free. Mean Wexner score at 12 months after operation was 2.3.
  
  
  CONCLUSIONS
  Totally laparoscopic sigmoid colectomy using TASE and the Alexis appears to be feasible, safe, and oncologically acceptable for selected cases.
authors.affiliation: Department of Surgery, Institute of Gastroenterology, Nagaoka Chuo General Hospital, Nagaoka, Japan. a-west@next.odn.ne.jp
authors.forename: Atsushi
authors.initials: A
authors.lastname: Nishimura
authors.forename: Mikako
authors.initials: M
authors.lastname: Kawahara
authors.forename: Kazuyoshi
authors.initials: K
authors.lastname: Suda
authors.forename: Shigeto
authors.initials: S
authors.lastname: Makino
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Kawachi
authors.forename: Keiya
authors.initials: K
authors.lastname: Nikkuni
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003082:Colectomy / Q000295:instrumentation / Q000379:methods*; D012809:Colon, Sigmoid / Q000601:surgery*; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000601:surgery*; D004867:Equipment Design; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000295:instrumentation / Q000379:methods*; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011446:Prospective Studies; D013525:Surgical Instruments; D017792:Surgical Stapling; D016896:Treatment Outcome