title: [Implementation of hybrid-NOTES sigmoidectomy for diverticular disease : In a center for minimally invasive surgery].
abstract: BACKGROUND
  Natural orifice transluminal endoscopic surgery (NOTES) describes surgical procedures through a natural orifice. In hybrid-NOTES small transabdominal trocars are combined with a NOTES access.
  
  
  OBJECTIVE
  To evaluate hybrid-NOTES sigmoidectomy as a standard procedure for diverticulitis.
  
  
  METHODS
  Elective laparoscopic sigmoidectomies performed between May 2011 and January 2016 were prospectively collated. Primary endpoint was the feasibility of hybrid-NOTES sigmoidectomy. The reasons for planning a laparoscopically-assisted sigmoidectomy (LAS), intraoperative change of treatment and reactive conversion were evaluated. Secondary endpoints were complications and operative time.
  
  
  RESULTS
  Out of 130 laparoscopic sigmoidectomies 83% were planned for hybrid-NOTES and 8 out of 52 (15%) transvaginal (TVS) and 14 out of 56 (25%) transrectal (TRS) sigmoidectomies were intraoperatively changed to LAS. The reason for the change in 64% was that the specimen was too bulky and 80% of scheduled hybrid-NOTES procedures were carried out as planned. The operative time for TVS (146.8 ± 44.5 min) was shorter compared to LAS (173.2 ± 58.8 min, P = 0.016). The morbidities of TVS (15.3%) and TRS (14.9%) were not significantly different from LAS (23.9%, P = 0.501 and P = 0.537, respectively).
  
  
  CONCLUSIONS
  Hybrid-NOTES for diverticular disease may be indicated in more than 80% of cases. In respect of intraoperative change of treatment, hybrid-NOTES is feasible in two thirds of patients. Given a high level of expertise, hybrid-NOTES can be provided as a standard procedure in sigmoidectomy for diverticular disease.
authors.affiliation: Klinik für Chirurgie, Kantonsspital Baselland, 4101, Bruderholz, Schweiz. Daniel.steinemann@gmx.ch.|Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland. Daniel.steinemann@gmx.ch.
authors.forename: D C
authors.initials: DC
authors.lastname: Steinemann
authors.affiliation: Klinik für Chirurgie, Kantonsspital Baselland, 4101, Bruderholz, Schweiz.|eSwiss Medical and Surgical Center, Spital Stephanshorn, Brauerstrasse 97, 9016, St. Gallen, Schweiz.
authors.forename: A
authors.initials: A
authors.lastname: Zerz
authors.affiliation: Klinik für Chirurgie, Kantonsspital Baselland, 4101, Bruderholz, Schweiz.
authors.forename: S H
authors.initials: SH
authors.lastname: Lamm
mesh_terms: D000328:Adult; D000368:Aged; D003131:Combined Modality Therapy / Q000706:statistics & numerical data; D061887:Conversion to Open Surgery / Q000706:statistics & numerical data; D004239:Diverticulitis, Colonic / Q000601:surgery*; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000601:surgery; D010535:Laparoscopy / Q000379:methods* / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D057605:Natural Orifice Endoscopic Surgery / Q000379:methods* / Q000706:statistics & numerical data; D061646:Operative Time; D011446:Prospective Studies; D012810:Sigmoid Diseases / Q000601:surgery*
keywords: Diverticulitis; Laparoscopy; Minimally invasive surgical procedures; Natural orifice endoscopic surgery; Sigmoid colon