Transanal Hybrid Sigmoid Resection -introduction Into Clinical Practice

Karl H Fuchs, MD, Wolfram Breithaupt, MD, Gabor Varga, MD, Thomas Schulz, MD. AGAPLESION Markus Krankenhaus

Introduction: Reducing access size and trauma is one of the important issues behind Natural orifice translumenal endoscopic surgery(NOTES). The combination of experience with Laparoscopic colorectal surgery(LCS) and Transanal endoscopic Microsurgery(TEM) has helped in using the transanal approach as a realistic option of NOTES-techniques to introduce transanal Hybrid laparoscopic assisted sigmoid resection into clinical practice.
Aim: The purpose of this study is the assessment of the clinical introduction of transanal hybrid sigmoid resection regarding feasibility and patient`s safety.
Methods: The authors have clinical experience in LCS, TEM and extensive training in NOTES-techniques. Patients were recruited with pelvic floor disorders and prolaps, in whom a sigmoid resection was indicated. Patients were followed prospectively with a postoperative well-being score, a pain score as well as quality of life score. All complications were prospectively documented. Reducing number and sizes of ports by using the transanal route was the essential change. Camera and two 5mm ports for grasping forceps and ultrasonic dissection power remained the laparoscopic component. All tasks requiring a port diameter >5mm were allocated at the transanal route such as trananal positioning of the proximal stapler envil, trananal application of linear stapling for resection, transanal specimen retrieval, transanal stapler anastomosis and closing the bowel.
Results: Eighteen patients with rectal prolaps underwent transanal hybrid sigmoid resection and pexy (all female; age 61 years (28-86); BMI 25). Conversion: 1 to full laparoscopy; complications: 1 bleeding(no reintervention); duration of procedure: 131 min(55-184). Gastrointestinal quality of Life index pre/post 96/117.
Conclusion: Transanal hybrid sigmoid resection seems from this initial experience a feasible and rather safe method of Hybrid-NOTES procedure to introduce into clinical practice.