title: [Transanal extraction vs. minilaparotomy : For laparoendoscopic left-sided colon resection].
abstract: BACKGROUND
  Recent developments in classical minimally invasive surgical procedures for colon resection aimed to minimize or even eliminate abdominal wall incisions, thus improving postoperative pain, patient recovery and aesthetics. A promising approach is the total laparoendoscopic colectomy (LEC) with transanal sample extraction. The aim of this study was the comparison of total LEC with conventional laparoscopic assisted surgery (LAS) and extraction incision.
  
  
  METHODS
  We included 168 consecutive patients (LEC:112; LAS:56) with diverticular disease, rectal prolapse, benign or malignant tumors and analyzed retrospectively. The specimen was extracted transanally by LEC with a specially developed rectoscope; the LAS group required a minilaparotomy of 5 cm. The primary outcome was postoperative pain. Secondary outcomes included operating time, minor and major complication rates, number and length of extracted specimens, additional pain medication and duration of hospital stay.
  
  
  RESULTS
  The measured postoperative pain score values did not significantly differ between the two groups; however, consumption of postoperative pain medication was significantly higher in the LAS-group (p < 0.001). Due to the learning curve, the median operating time in the LEC group (120 min) was slightly longer than in the LAS group (100 min); however, it was reduced to 95 min in the last 50 operations. Patients in the LEC group were discharged from hospital one day earlier (median duration of hospital stay 6 days, p = 0.003). Compliaction rates were similar in both groups.
  
  
  CONCLUSIONS
  The technique of total LEC with transanal specimen extraction is designed to avoid a minilaparotomy and its associated morbidities. The LEC operation is feasible for a large group of patients, including overweight patients. The superiority of LEC in terms of reduced pain medication, shorter hospital stay and faster patient recovery, as shown in this study, needs to be confirmed by randomized controlled trials with longer follow-up periods.
authors: Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen (IQWiG), Ressort Medizinische Biometrie, Köln, Deutschland.|Institut für Gesundheitsökonomie und Klinische Epidemiologie, Universität zu Köln, Köln, Deutschland.
authors: A C
authors: AC
authors: Brockhaus
authors: Klinikum Oberberg, Klinik für Allgemein-, Viszeral- und Thoraxchirurgie, Kreiskrankenhaus Gummersbach, Wilhelm Breckow Allee 20, 51643, Gummersbach, Deutschland.
authors: D
authors: D
authors: Politt
authors: Klinikum Oberberg, Klinik für Allgemein-, Viszeral- und Thoraxchirurgie, Kreiskrankenhaus Gummersbach, Wilhelm Breckow Allee 20, 51643, Gummersbach, Deutschland.
authors: C
authors: C
authors: Lindlohr
authors: Klinikum Oberberg, Klinik für Allgemein-, Viszeral- und Thoraxchirurgie, Kreiskrankenhaus Gummersbach, Wilhelm Breckow Allee 20, 51643, Gummersbach, Deutschland. stefan.saad@kkh-gummersbach.de.
authors: S
authors: S
authors: Saad
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003082:Colectomy / Q000295:instrumentation / Q000379:methods*; D015179:Colorectal Neoplasms / Q000601:surgery*; D004239:Diverticulitis, Colonic / Q000601:surgery*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000295:instrumentation / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000295:instrumentation / Q000379:methods*; D010149:Postoperative Pain / Q000209:etiology / Q000517:prevention & control; D011351:Proctoscopy / Q000295:instrumentation / Q000379:methods*; D012005:Rectal Prolapse / Q000601:surgery*; D012189:Retrospective Studies
keywords: Minilaparotomy; Minimally invasive surgery; Total laparoscopic left colon resection; Total laparoscopic sigmoid colon resection; Transanal extraction