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Initial experience of laparoscopic total colectomy with transanal minimally invasive proctectomy for ulcerative colitis

Takatoshi Matsuyama, Sinichi Yamauchi, Akifumi Kikuchi, Kazuyuki Kojima, Yasuaki Nakajima, Masamichi Yasuno, Yusuke Kinugasa. Tokyo Medical and Dental University

Objective of the technology or device: Laparoscopic surgery is well established for colon cancer, with defined benefits. Use of laparoscopy for the performance of restorative proctocolectomy (RPC) with ileoanal anastomosis is more controversial. There are several technical hurdles occurring during laparoscopic pelvic dissection and distal rectal transection. Recently, transanal surgical techniques have been explored in the total mesorectal excision (TME) surgery, and have shown encouraging low conversion rates in a recent registry analysis mainly for rectal cancer. In an attempt to overcome the difficulties during laparoscopic RPC, we have used the technique of transanal minimally invasive proctectomy (TAMIP).

Description of the technology and method of its use or application: This method is laparoscopic surgery with a combination of transanal endoscopic surgery for RPC. For the transanal procedure, mucosectomy is commenced from dentate line and mucosal stump is closed by a purse-string suture manually. When dysplasia is not the indication for surgery or when the distal proctitis is not severe anal transition zone is left to reduce the risk of continence disturbance. The GelPoint Path transanal device (Applied Medical, Rancho Santo Margarita, California, USA) is placed in the anal canal. Carbon dioxide is insuf?ated to a pressure of 10 mmHg. The dissection is started using a Spatula type electric scalpel with Airseal system (Milford, Connecticut, USA) with the aim of removing smoke, which can hamper vision. After 2cm mucosectomy, dissecting layer is shifted to the layer of TME. Total mesorectal dissection is completed by the abdominal and transanal approach sequentially or simultaneously. Simultaneous dissection reduces the operation time and can make the operation easier. Once the proctectomy is completed the specimen is brought out through the anal. The J-pouch is created by standard stapling after bringing the ileum out through the stoma site. The anastomosis was performed manually. A loop ileostomy is always created.

Preliminary results: The procedure was performed on 7 patients with a median age of 28 (15-62) years. The male: female ratio was 3: 4 and the median hospital stay was 12 (6-23) days. The median operation time was 445 (286-524) min and median blood loss was 150ml (96-393) ml. The overall conversion rate to open surgery was 0%. The 30-day surgical complication rate was 14.2% (Clavien-Dindo grade 1 in one patient).

Conclusions / future directions: This initial study has demonstrated the feasibility and safety of TAMIP combined with laparoscopic surgery when performing RPC with ileal pouch-anal anastomosis for ulcerative colitis.


Presented at the SAGES 2017 Annual Meeting in Houston, TX.

Abstract ID: 91243

Program Number: ETP864

Presentation Session: Emerging Technology iPoster Session (Non CME)

Presentation Type: Poster

31

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