Totally Laparoscopic Proctocolectomy with Intracorporeal Ileal Pouch -Anal Anastomosis Followed By ‘natural Orifice Specimen Extraction’ (n.o.s.e)

Totally laparoscopic proctocolectomy with intracorporeal pouch-anal anastomosis has been rarely reported. In this video, we present a totally laparoscopic proctocolectomy with pouch-anal anastomosis and a novel method of specimen extraction.

Methods: We retrospectively studied 7 female patients from 2004-2007. A totally laparoscopic proctocolectomy with ileal pouch-anal anastomosis was successfully performed for all cases. The operating surgeon changes position around the patient during the course of te procedure. The mobilization was commenced from the left side of the transverse colon, proceeding to the right side, right colon and cecum. Next, the left colon, sigmoid and rectum were mobilized. After resection of the colon, lieal J-pouch construction and anal anastomosis were performed using both linear and circular staplers, aided by the perineal surgeon. The entire specimen was placed in an endobag and extracted via a transvaginal route.
Results: The mean age of the patients was 49.5 years, and mean BMI was 25.3 kg/m2. The mean operating time was 222.5 minutes, and average blood loss was 172 ml. The mean hospital stay was 8 days. Postoperative complications included ileus (n=1) and pouchitis (n=1). The vaginal wound had healed completely by the first follow up. There was no conversion and mortality.

Conclusion: This technique of totally laparoscopic proctocolectomy with pouch-anal anastomosis is feasible, and has the advantage of avoiding a minilaparotomy. Our technique of transvaginal specimen retrieval compliments this, and effectively prevents wound-related complications like port-site metastasis, hernia, infection, pain and cosmesis.

Session: Podium Video Presentation

Program Number: V045

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