Daniel C Steinemann, MD, Andreas Zerz, MD, Sebastian H Lamm, MD. Cantonal Hospital Basel Country, Department of Surgery, Bruderholz, Switzerland.
Objective: Although, in standard laparoscopy anterior resection can usually be performed using two five millimetres incisions and two twelve millimetre trocar (for insertion of the Endostapler), there remains the need for a minilaparotomy for specimen removal. The removal of the specimen through the rectum avoids a minilaparotomy and therefore aditional harm to the abdominal wall.
In our opinion the rigid hybrid-NOTES technique is the perfect tool to convert laparoscopic assisted operations into totally laparoscopic procedures.
Methods: In this instructive HD 3D video we present our technique of transrectal laparoscopic anterior resection in diverticular disease.
Results: After positioning of the patient the procedure is started with our standard medial mobilization of the left hemicolon. Afterwards the infrapancreatic ligation of the inferior mesenteric vein and the central ligation of the inferior mesenteric artery are performed with the energy device. The mobilization is completed from lateral. Afterwards the proximal rectum is preparated and the anterior resection is performed. The specimen is extracted transrectally, followed by an intracorporal purse-string suture after insertion of the anvil in the oral colon. A circular stapler is inserted transanally and the end-to-end anastomosis is performed.
Conclusion: In our experience on 27 patients the transrectal hybrid-NOTES anterior resections is a safe and feasible evolution of the standard laparoscopic procedure. The 3 D depth perception improves the accuracy and precision of surgical tasks.