A novel single-port technique for transanal rectosigmoid resection and colorectal anastomosis on an ex vivo experimental model
A novel single-port technique for transanal rectosigmoid resection and colorectal anastomosis on an ex vivo experimental model
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DOI：
10.1007/s00464-010-1476-1
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发表时间：
2011-06-01
影响因子：
3.1
通讯作者：
Misra, Mahesh C.
中科院分区：
文献类型：
--
作者：
Bhattacharjee, Hemanga K.;Buess, Gerhard F.;Misra, Mahesh C.
在自然口经肛门内镜手术（NOTES）的背景下，我们根据经肛门内镜显微手术（TEM）的原理开发了一套新的刚性器械。这些仪器长而弯曲，通过转动手柄附近的两个轮子来操纵。我们在经阴道人类胆囊切除术中使用这些器械的成功促使我们探索经肛门切除直肠乙状结肠的可行性。方法整块收集牛小肠，并将其与附着器官整合到一个解剖学设计的训练器中，以再现人体解剖结构。该技术包括以下内容：(1)通过腔内钱包线缝合直肠管腔；(2)直肠壁横切至囊绳缝合线远1 cm处，沿筋膜方向继续剥离，向上切除直肠系膜组织；(3)肠系膜下动脉在其起源附近分裂；(4)结肠被动员到脾曲处；(5)将活动的结肠降至骨盆，在拟近端切除部位结扎两次，并在结扎之间分开；(6)经肛送标本；(7)采用吻合器或手缝合吻合术恢复肠道连续性。结果共行直肠乙状结肠切除术12例，吻合术20例，手吻合术27例。切除部分平均手术时间78.6 min（标准差(SD) = 9.9）。标本平均长度为37.2 cm。在骨盆剥离过程中，当标本被向上推至腹部时，工作区域的“空骨盆”视图得以实现，便于剥离。手工缝合和吻合器的平均手术时间分别为47.7 （SD = 6.9）和43.3 (SD = 7.1) min。两组均有1例吻合口瘘。结论瞬变电磁法经肛乙状直肠切除术是可行的。通畅的“空骨盆”观可能提高直肠系膜剥离的质量。
Background In the context of natural orifice translumenal endoscopic surgery (NOTES), we developed a new set of rigid instruments according to the principles of transanal endoscopic microsurgery (TEM).These instruments are long, curved, and steerable by rotating two wheels near its handle. Our success in transvaginal cholecystectomy in human with these instruments motivated us to explore the feasibility of rectosigmoid resection through the anus.Methods The young bovine large bowel with attached organs is collected en bloc and reintegrated into an anatomically designed trainer to reproduce the human anatomy. The technique comprises the following: (1) closure of the rectal lumen by an endolumenal pursestring suture; (2) transection of the rectal wall 1 cm distal to the pursestring suture and continuation of the dissection toward the fascia and upward excising the mesorectal tissue; (3) inferior mesenteric artery is divided near its origin; (4) the colon is mobilized up to the splenic flexure; (5) the mobilized colon is brought down to the pelvis, ligated twice at the intended proximal resection site, and divided between the ligatures; (6) specimen is delivered transanally; and (7) intestinal continuity is restored by stapled or hand-sutured anastomosis.Results Twelve rectosigmoid resections, 20 stapled, and 27 hand-sutured anastomoses were performed in two experimental setups. Mean operation time for the resection part was 78.6 min (standard deviation (SD) = 9.9). The average specimen length was 37.2 cm. During dissection in the pelvis, as the specimen was pushed upward and toward abdomen, an "empty pelvis" view of the working field was achieved, facilitating dissection. The mean operation time for hand-sutured and stapled anastomoses were 47.7 (SD = 6.9) and 43.3 (SD = 7.1) min, respectively. Both groups had one anastomotic leak.Conclusions Transanal rectosigmoid resection is feasible with TEM technology. The unobstructed "empty pelvis" view is likely to enhance the quality of mesorectal dissection.