Totally transanal laparo-endoscopic single-site ileal J-pouch (TLPC-J) – Experimental study in 6 fresh human cadavers of a novel approach for avoiding abdominal wall incision for total colectomy

Reza M. Vahdad1, Grigore Cernaianu2, Thomas Boemers1, Hamid R. Foroutan3. 1Children’s Hospital Cologne Amsterdamer Strasse, Department of Pediatric Surgery and Pediatric Urolo, 2University Hospital Lubeck, Department of Pediatric Surgery, Lubeck, Germany,, 3Shiraz University of Medical Sciences, Department of Pediatric Surgery, Nemazee Hospital, Shiraz, I

Background:
Completely avoiding abdominal wall incisions through the use of transanal laparoscopic access represents the most current evolution in minimally invasive surgery. The combination of laparo-endoscopic single-site (LESS) surgery and natural orifice transluminal endoscopic surgery (NOTES™) can achieve totally transanal LESS pullthrough colectomy (TLPC) and creation of a totally transanal ileal J-pouch (TLPC-J). The novel aim of our experimental study was to provide evidence that TLPC-J is feasible in adult human cadavers.

Methods:
TLPC-J was performed in six fresh human adult cadavers (Fig 1-13). The TLPC-J procedure consisted of an endorectal technique with submucosal dissection starting 1 cm orally from the dentate line to above the peritoneal reflection, where the rectal muscle was divided circumferentially. After ligation of the rectal mucosa, the proximal bowel was replaced into the abdominal cavity and a TriPort® was introduced transanally. Mesenterial resection of the complete colon, mobilization of a distal ileal segment, and extra corporeal suture of an ileal J-loop were accomplished via the transanal approach. Both straight and curved scopes were used. The mobilized ileum was reached and pulled down to the site of anastomosis. An incision in the J-loop was accomplished transanally. The J-pouch was created with an Endo-GIA®. After removal of the TriPort® the J-pouch was sutured to the rectal wall.

Results: In human adult cadavers the use of a curved endoscope greatly facilitated transanal laparoscopic dissection making TLPC-J feasible.

Conclusion: We show for the first time that total colectomy and creation of an ileal J-pouch without abdominal incision is feasible in fresh human cadavers.

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