An experimental study in six fresh human cadavers using a novel approach to avoid abdominal wall incisions in total colectomy: totally transanal laparoendoscopic single-site pull-through colectomy with J-pouch creation.
The use of transanal laparoscopic access to completely avoid abdominal wall incisions represents the most current evolution in minimally invasive surgery. The combination of single-site surgery and natural orifice transluminal endoscopic surgery (NOTES™) can be used for totally transanal laparoendoscopic pull-through colectomy with J-pouch creation (TLPC-J). The aim of the present study was to provide evidence for the feasibility of TLPC-J in adult human cadavers.



TLPC-J was performed in six fresh adult human cadavers. The procedure involved endorectal submucosal dissection from 1 cm above the dentate line to a point above the peritoneal reflection, where the rectal muscle was divided circumferentially. The edge of the mucosal cuff was closed distally in order to prevent fecal contamination and the endorectal tube was placed back into the abdomen. A Triport+™ or QuadPort+™ system was introduced transanally, and it served as a multiport device (MD). Resection of the entire colon, mobilization of the distal ileal segment, and extracorporeal suture of the ileal J-loop were performed via the transanal approach. The J-pouch was created using Endo GIA™. After removal of the MD, the J-pouch was sutured to the rectal wall.



TLPC-J was performed in all cadavers, with a mean operation duration of 236 ± 22 min. Conversion to either transabdominal laparoscopy or laparotomy was not required in any of the cadavers. No bowel perforation or damage to other organs was observed. The use of a curved endoscope greatly facilitated visualization during transanal laparoscopic dissection for partial and total colectomy, making the procedure feasible. All specimens were retrieved through the anus, eliminating the need for additional transabdominal incisions.



TLPC-J was technically feasible in adult human cadavers, and abdominal wall incisions were not required. However, clinical studies are needed to determine its feasibility in living adults.
Department of Pediatric Surgery and Pediatric Urology, Kliniken der Stadt Köln gGmbH, Kinderkrankenhaus Amsterdamer Strasse 59, 50735, Cologne, Germany. rvahdad@aol.com.
M Reza
0000-0002-2169-6305
MR
Vahdad
Department of Pediatric Surgery, University Hospital Cologne, Kerpenerstr. 62, 50937, Cologne, Germany.
Grigore
G
Cernaianu
Department of Pediatric Surgery and Pediatric Urology, Kliniken der Stadt Köln gGmbH, Kinderkrankenhaus Amsterdamer Strasse 59, 50735, Cologne, Germany.
Alexander
A
Semaan
Department of Pediatric Surgery and Pediatric Urology, Kliniken der Stadt Köln gGmbH, Kinderkrankenhaus Amsterdamer Strasse 59, 50735, Cologne, Germany.
Tobias
T
Klein
Olympus Surgical Technologies Europe, Kuehnstraße 61, 22045, Hamburg, Germany.
Samuel
S
Faran
White Plains Hospital, 210 Westchester Avenue, White Plains, NY, 10604, USA.
Harry
H
Zemon
Department of Pediatric Surgery and Pediatric Urology, Kliniken der Stadt Köln gGmbH, Kinderkrankenhaus Amsterdamer Strasse 59, 50735, Cologne, Germany.
Thomas
T
Boemers
Department of Pediatric Surgery, Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, 7141995377, Iran.
Hamid Reza
HR
Foroutan
D034841:Abdominal Cavity; D000007:Abdominal Injuries / Q000517:prevention & control*; D034861:Abdominal Wall / Q000601:surgery; D000328:Adult; D002102:Cadaver; D003082:Colectomy / Q000379:methods*; D005260:Female; D006801:Humans; D007049:Iatrogenic Disease / Q000517:prevention & control; D007416:Intestinal Perforation / Q000517:prevention & control; D010535:Laparoscopy; D008297:Male; D057605:Natural Orifice Endoscopic Surgery / Q000379:methods*
Colectomy; Natural orifice transluminal endoscopic surgery; Transanal; Transanal minimally invasive surgery