Published online Nov 16, 2020. doi: 10.4253/wjge.v12.i11.451
Peer-review started: July 16, 2020
First decision: September 14, 2020
Revised: September 29, 2020
Accepted: October 20, 2020
Article in press: October 20, 2020
Published online: November 16, 2020
Processing time: 122 Days and 23.9 Hours
Since 1991, an increasing number of minimally invasive surgical techniques, including single-incision laparoscopic surgery (SILS), needlescopic surgery (NS), and natural orifice transluminal endoscopic surgery (NOTES), have been developed rapidly. To date, all cases of NOTES colorectal resection have included a hybrid laparoscopic approach with the use of established rigid platforms.
Our research aimed to improve NOTES-related techniques.
Our study aimed to introduce the novel technique of peroral external traction-assisted transanal NOTES sigmoidectomy followed by intracorporeal colorectal end-to-end anastomosis by using only currently available and flexible endoscopic instrumentation in a live swine model.
Three female pigs weighing 25-30 kg underwent NOTES rectosigmoid resection. The procedure of trans-anal NOTES rectosigmoidectomy included the following eight steps: (1) The rectosigmoid colon was tattooed with India ink by submucosal injection; (2) Creation of gastrostomy by directed submucosal tunneling; (3) Peroral external traction using endoloop ligation; (4) Creation of rectostomy on the anterior rectal wall by directed 3 cm submucosal tunneling; (5) Peroral external traction-assisted dissection of the left side of the colon; (6) Trans-anal rectosigmoid specimen transection, where an anvil was inserted into the proximal segment after purse-string suturing; (7) Intracorporeal colorectal end-to-end anastomosis using a circular stapler with a single stapling technique; and (8) Closure of gastrostomy using endoscopic clips.
The procedure was completed in all three animals, with the operation time ranging from 193 min to 259 min. The length of the resected specimen ranged from 7 cm to 13 cm. With the assistance of a trans-umbilical rigid grasper, intracorporeal colorectal, tension-free, end-to-end anastomosis was achieved in the three animals.
Peroral traction-assisted transanal NOTES rectosigmoidectomy followed by intracorporeal colorectal end-to-end anastomosis is technically feasible and reproducible in an animal model and is worthy of further improvements.
The techniques of NOTES rectosigmoidectomy need to be improved for clinical application.