title: Natural Orifice Transluminal Endoscopic Surgery (NOTES) for colon resections--analysis of the first 139 patients of the German NOTES Registry (GNR).
abstract: BACKGROUND
  The German NOTES registry (GNR) is the largest published database for natural orifice transluminal endoscopic surgery (NOTES) worldwide. Although transvaginal cholecystectomy is the most frequent procedure in the GNR, the number of colorectal resections is increasing. The objective of this study was to analyze the first 139 colonic procedures of the GNR.
  
  
  METHODS
  All colonic procedures from the GNR were analyzed regarding patient- and therapy-related parameters. A multivariate analysis was conducted for transvaginal sigmoid resections regarding procedural time, hospital stay, conversion rate, and rate of complications.
  
  
  RESULTS
  From October 2008 to January 2013, 139 colon NOTES procedures (12 male, 127 female) were registered. Main diagnoses were sigmoid diverticulitis (85.6 %), colon carcinoma (9.4 %), and ulcerative colitis (3.6 %). Sigmoid resections (87.1 %), proctocolectomies (3.6 %), right-sided resections (2.9 %), left-sided resections (3.6 %), segmental resections (2.2 %), and 1 ileocecal resection (0.7 %) were performed. All procedures were conducted in transvaginal (87.8 %) or transrectal (12.2 %) hybrid technique, with a median of 3 percutaneous trocars. Conversions to laparoscopic technique were necessary in 3.6 % (none to conventional technique). Intraoperative complications were recorded in 2.9 % and postoperative complications in 12.2 %. The institutional case number in transvaginal sigmoid resections correlated negatively with procedural time (p = 0.041) and the number of percutaneous trocars (p = 0.002).
  
  
  CONCLUSIONS
  The analysis of the first 139 colon NOTES operations of the GNR shows the feasibility of co on operations in hybrid technique, especially for transvaginal sigmoid resection as the most frequent procedure.
authors.affiliation: Department of Abdominal, Vascular and Transplant Surgery, Cologne-Merheim Medical Center, Witten/Herdecke University, Ostmerheimer Strasse 200, 51109, Cologne, Germany, buliand@kliniken-koeln.de.
authors.forename: Dirk R
authors.initials: DR
authors.lastname: Bulian
authors.forename: Norbert
authors.initials: N
authors.lastname: Runkel
authors.forename: Jens
authors.initials: J
authors.lastname: Burghardt
authors.forename: Wolfram
authors.initials: W
authors.lastname: Lamade
authors.forename: Michael
authors.initials: M
authors.lastname: Butters
authors.forename: Markus
authors.initials: M
authors.lastname: Utech
authors.forename: Klaus-Peter
authors.initials: KP
authors.lastname: Thon
authors.forename: Rolf
authors.initials: R
authors.lastname: Lefering
authors.forename: Markus M
authors.initials: MM
authors.lastname: Heiss
authors.forename: Heinz J
authors.initials: HJ
authors.lastname: Buhr
authors.forename: Kai S
authors.initials: KS
authors.lastname: Lehmann
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002432:Cecum / Q000601:surgery; D003082:Colectomy / Q000379:methods; D003093:Colitis, Ulcerative / Q000601:surgery; D003106:Colon / Q000601:surgery*; D012809:Colon, Sigmoid / Q000601:surgery; D003110:Colonic Neoplasms / Q000601:surgery; D004239:Diverticulitis, Colonic / Q000601:surgery; D005260:Female; D005858:Germany; D006801:Humans; D007082:Ileum / Q000601:surgery; D007431:Intraoperative Complications; D008297:Male; D008875:Middle Aged; D057605:Natural Orifice Endoscopic Surgery; D011183:Postoperative Complications; D012042:Registries; D055815:Young Adult