Transvaginal Rigid-hybrid Natural Orifice Transluminal Endoscopic Surgery Technique for Anterior Resection Treatment of Diverticulitis: a Feasibility Study

Overview

Journal Surg Endosc

Publisher Springer

Specialties Gastroenterology
General Surgery
Radiology

Date 2011 Apr 14

PMID 21487875

Citations 18

Authors

Ignazio Tarantino

Georg R Linke

Jochen Lange

Ikbale Siercks

Rene Warschkow

Andreas Zerz

Affiliations

Soon will be listed here.

Abstract

Background: In laparoscopic anterior resection, minilaparotomy still is required. Recently, transvaginal hybrid natural orifice transluminal endoscopic surgery (NOTES) techniques for cholecystectomy have been described. Reports on operations that require removal of larger specimens, as in anterior resection, are scarce and limited primarily to small case series and case reports. The current study aimed to evaluate the feasibility and safety of transvaginal rigid-hybrid NOTES anterior resection (tvAR) for symptomatic diverticular disease.

Methods: All female patients presenting with symptomatic diverticulitis of the sigmoid colon were candidates for inclusion in the study. The exclusion criteria specified failure to sign informed consent, previous colorectal resection, anesthesiologic contraindication for pneumoperitoneum, liver failure and coagulopathy, severe acute diverticular bleeding, internal fistula with abscess (Hinchey 2b), perforated diverticulitis with peritonitis (Hinchey 3 or 4), gynecologic or urologic contraindications, and absence of preoperative gynecologic examination. A preoperative and 2-week postoperative gynecologic examination was performed. Quality of life and sexual function were assessed preoperatively and 6 weeks postoperatively.

Results: Of 70 patients, 45 (64.3%) were scheduled for tvAR. Five patients were withdrawn at the beginning of laparoscopy with no transvaginal access performed. Of the remaining 40 patients with attempted tvAR, 4 patients underwent conversion to a minilaparotomy (Pfannenstiel incision) and 2 patients were converted to a total median laparotomy. For 34 patients (85%), the operation was completed transvaginally. A total of 2 major complications and 10 minor complications occurred. No serious postoperative gynecologic morbidity was experienced. At 6 weeks postoperatively, sexual function did not differ significantly from preoperative status.

Conclusions: For symptomatic diverticular disease, TvAR is feasible, although the presented technique requires laparoscopic expertise and further refinement.

Citing Articles

Transvaginal Hybrid NOTES Cholecystectomy: A Single-Centre Long-Term Experience on Sexual Function.

Pohlen U, Feller A, Holmer C World J Surg. 2017; 42(7):1960-1964.

PMID: 29270655 DOI: 10.1007/s00268-017-4412-x.

Feasibility and Technique for Transvaginal Natural Orifice Transluminal Endoscopic Surgery Liver Resection: A Porcine Model.

Katagiri T, Otsuka Y, Horgan S, Sandler B, Jacobsen G, Coker A Surg Laparosc Endosc Percutan Tech. 2016; 27(1):e6-e11.

PMID: 28030435 PMC: 5287436. DOI: 10.1097/SLE.0000000000000367.

[Implementation of hybrid-NOTES sigmoidectomy for diverticular disease : In a center for minimally invasive surgery].

Steinemann D, Zerz A, Lamm S Chirurg. 2016; 88(6):518-524.

PMID: 27928602 DOI: 10.1007/s00104-016-0333-8.

New device for transrectal trocar placement and rectal sealing for NOTES: a porcine in vivo and human cadaver study.

Senft J, Gath P, Droscher T, Muller P, Carstensen B, Nickel F Surg Endosc. 2016; 30(10):4383-8.

PMID: 27059964 DOI: 10.1007/s00464-016-4756-6.

Systematic Review and Meta-analysis of Complications in Transvaginal Approach in Laparoscopic Surgery.

Komorowski A, Alba Mesa F, Bala M, Mitus J, Wysocki W Indian J Surg. 2016; 77(Suppl 3):853-62.

PMID: 27011470 PMC: 4775556. DOI: 10.1007/s12262-014-1038-1.

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