title: Incisionless laparoscopic total proctocolectomy with ileal J-pouch anal anastomosis.
abstract: Minimally invasive surgery continues to evolve. Recent innovations have included single-incision access, robotic technology, and natural orifice dissection and/or specimen extraction. Many argue that there is minimal patient benefit to these advanced techniques. We report 39 patients  undergoing laparoscopic ileal J-pouch anal anastomosis surgery, 17 of whom did not have a separate specimen extraction incision (Group 1). The specimen for this group was extracted through the circular incision made for the ileostomy; the pouch was constructed extracorporeally and returned  to the abdomen through the stoma site. For the remaining 22 patients, a suprapubic Pfannenstiel incision was made (Group 2). No hand-assistance was used for either group. Group 1 showed a 45-minute reduction in operative time, a 1-day reduction in hospital stay, and a reduction in complications.  Although these differences are modest, it shows that minimally invasive surgery is an evolving process. Small modifications may translate into significant advantages.
authors.affiliation: Section of Colon and Rectal Surgery, Department of General Surgery, Rush University Medical Center, Chicago, Illinois, USA.
authors.forename: Francisco
authors.initials: F
authors.lastname: Abarca
authors.forename: Kyle G
authors.initials: KG
authors.lastname: Cologne
authors.forename: Amanda
authors.initials: A
authors.lastname: Francescatti
authors.forename: Marc I
authors.initials: MI
authors.lastname: Brand
authors.forename: Theodore J
authors.initials: TJ
authors.lastname: Saclarides
mesh_terms: D000328:Adult; D000368:Aged; D001003:Anal Canal / Q000601:surgery*; D000714:Anastomosis, Surgical / Q000379:methods; D039021:Colonic Pouches; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D016737:Proctocolectomy, Restorative / Q000379:methods*; D012189:Retrospective Studies; D055815:Young Adult