Kyung Su Han, MD, Dae Kyung Sohn, MD PhD, David W Rattner, MD, Patricia Sylla, MD. Massachusetts General Hospital
We describe NOTES total colectomy with transanal and transgastric assistance in a male cadaver. The distal rectum was occluded by placing a pursestring suture approximately 2 cm above the dentate line, above the sphincter complex. The TEM platform (transanal endoscopic microsurgery) was inserted transanally and CO2 was insufflated. Starting just distal to the pursestring, full-thickness rectal dissection with total mesorectal excision was performed endoscopically through the TEM platform using TEM and laparoscopic instrumentation. Upon completion of the rectal and mesorectal dissection and entry into the peritoneal cavity, the IMA pedicle and rectosigmoid mesentery were divided and the sigmoid and left colon were further mobilized towards the splenic flexure. At that point, more proximal colon mobilization was performed with transgastric endoscopic assistance using a double-channel gastroscope. Mobilization of the transverse and right colon dissection were completed using combined transgastric and transanal endoscopic approach. The colon was exteriorized transanally. The total specimen length was 150 cm and the operative time was 450 minutes.
Session Number: SS25 – Videos: NOTES / Flexible Endoscopy
Program Number: V065