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首页> 外文期刊>Surgical Endoscopy >Totally laparoscopic sigmoid colectomy with transanal specimen extraction.
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Totally laparoscopic sigmoid colectomy with transanal specimen extraction.

机译：完全腹腔镜乙状结肠切除术并经肛门抽取标本。

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BACKGROUND: Conventional techniques for laparoscopic-assisted colectomy (LAC) require abdominal minilaparotomy for extraction of the specimen. Abdominal wound complications often increase the invasiveness of LAC. To decrease the incidence of wound complications, natural orifice specimen extraction (NOSE) has been reported. However, only a few devices that allow smooth extraction and reduced intracorporeal contamination have been reported previously. We performed totally laparoscopic sigmoid colectomy using transanal specimen extraction (TASE) and the Alexis((R)) wound retractor (Applied Medical, Rancho Santa Margarita, CA, USA). We document this simple and safe technique and its short-term results. METHODS: We prospectively collected data on 18 patients who underwent totally laparoscopic sigmoid colectomy with TASE from April 2009 to July 2010. Lymph node dissection and transection of proximal and distal colon were performed in conventional manner. The transected rectal stump was opened transversely, and a long Babcock grasper was inserted transanally through the opened rectal stump. One of a pair of Alexis rings was held and pulled out of the anus. The other ring was placed in the opened rectal stump. The specimen was then extracted transanally through the Alexis. After the Alexis had been removed, the rectal opening was reclosed with a linear stapler. End-to-end colorectal anastomosis was then performed using the double-stapling technique. RESULTS: Transanal extraction was achieved in 17 cases. We switched to conventional LAC in a case involving a bulky specimen. In 16 cases not including the combined cholecystectomy case, mean operation time was 241 min. One case was complicated by anastomotic leakage and wound infection, while another had enterocolitis. Median hospital stay was 6 days. All patients remained disease free. Mean Wexner score at 12 months after operation was 2.3. CONCLUSION: Totally laparoscopic sigmoid colectomy using TASE and the Alexis appears to be feasible, safe, and oncologically acceptable for selected cases.
机译：背景：腹腔镜辅助结肠切除术（LAC）的常规技术需要进行腹部小切口开腹术以提取标本。腹部伤口并发症通常会增加LAC的侵袭性。为了减少伤口并发症的发生，已经报道了天然孔口标本提取（NOSE）。但是，以前仅报道了少数能够平稳提取和减少体内污染的设备。我们使用经肛门标本提取（TASE）和Alexis（R）伤口牵开器（Applied Medical，Rancho Santa Margarita，CA，美国）进行了完全腹腔镜乙状结肠切除术。我们记录了这种简单安全的技术及其短期结果。方法：我们前瞻性收集了2009年4月至2010年7月接受TASE全腹腔镜乙状结肠切除术的18例患者的资料。以常规方式行淋巴结清扫术和近端结肠切除术。将横切的直肠残端横向打开，然后将一个长的Babcock抓取器穿过该残存的直肠残端经肛门插入。握住一对亚历克西斯环中的一个，将其拉出肛门。另一个环放在打开的直肠残端中。然后通过亚历克西斯经肛门抽取标本。除去Alexis后，用线性吻合器重新封闭直肠开口。然后使用双重吻合技术进行端到端结直肠吻合术。结果：经肛门抽出17例。在涉及笨重标本的情况下，我们改用常规LAC。在不包括联合胆囊切除术病例的16例中，平均手术时间为241分钟。一例并发吻合口漏和伤口感染，另一例患有小肠结肠炎。中位住院时间为6天。所有患者均无疾病。术后12个月的平均韦克斯纳评分为2.3。结论：使用TASE和Alexis进行全腹腔镜乙状结肠切除术对于某些病例似乎是可行，安全且在肿瘤学上可接受的。

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