title: Totally Transanal Laparo-Endoscopic Single-Site ProctoColectomy-Ileoanal J-Pouch (TLPC-J): An Experimental Study of a Novel Approach.
abstract: BACKGROUND
  The natural orifice transluminal endoscopic surgery (NOTES) has become a commonly considered novel approach in the surgical field. The NOTES provide possibility of operation through the natural orifice and decreases the intentional puncture of the systemic organ and subsequent complications. Totally transanal laparo-endoscopic single-site proctoColectomy-Ileoanal J-Pouch (TLPC-J) is a novel method in minimally invasive surgery for total colectomy. The main goal of this study is to perform this new method on an animal model, to assess probable complication and to resolve probable issues by using patients that are candidate for total colectomy.
  
  
  METHODS
  Five dogs were prepared in lithotomy position. The TLPC-I procedure consists of endorectal technique with full thickness rectal dissection starting 1 cm orally from the dentate line above the peritoneal reflection and the proximal bowel was replaced into the abdominal cavity. Afterwards, the TriPort system was inserted in the anal canal and mesentrial resection of the total colon, mobilization of a distal ileal segment and intracorporeal suture of an ileal J-loop was accomplished by this system. An incision in the J-loop was conducted transanally. The J-pouch was created with an Endo-GIA® and sutured to the rectal wall.
  
  
  RESULTS
  All animals survived and passed stool with clear post operation situation. There was no infection in site of anastomosis.
  
  
  CONCLUSIONS
  The TLPC-I provides the possibility of surgery without abdominal wall incision and decreases post operation complication such as pain, abdominal wound infection and wound dehiscence. This technique increases the quality of life and surgeons can discharge the patients early.
authors.affiliation: Department of Pediatric Surgery, Catholic Foundation Marienhospital Herne, Ruhr-University of Bochum, Herne, Germany.
authors.forename: Mohammad Reza
authors.initials: MR
authors.lastname: Vahdad
authors.affiliation: Department of General Surgery, Shahid Faghihi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran.
authors.forename: Ehsan
authors.initials: E
authors.lastname: Rahmanian
authors.affiliation: Colorectal Research Center, Shahid Faghihi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran.
authors.forename: Sam
authors.initials: S
authors.lastname: Moslemi
authors.affiliation: Department of Pediatric Surgery, Namazi Hospital, Shiraz University Laparoscopy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
authors.forename: Sultan Mohsen
authors.initials: SM
authors.lastname: Najafi
authors.affiliation: Department of Pediatric Surgery, Namazi Hospital, Shiraz University Laparoscopy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
authors.forename: Hamid Reza
authors.initials: HR
authors.lastname: Foroutan
keywords: Minimally invasive surgical procedures; Natural orifice transluminal endoscopic surgery