Totally laparoscopic sigmoid colectomy with transanal specimen extraction

Area of Science:

• Minimally invasive surgery
• Colorectal surgery
• Surgical oncology

Background:

• Conventional laparoscopic-assisted colectomy (LAC) often requires minilaparotomy for specimen extraction, increasing the risk of abdominal wound complications.
• Natural orifice specimen extraction (NOSE) techniques aim to reduce these complications, but few devices ensure smooth extraction and minimize contamination.
• This study introduces transanal specimen extraction (TASE) using the Alexis® wound retractor for totally laparoscopic sigmoid colectomy.

Purpose of the Study:

• To document a simple and safe technique for totally laparoscopic sigmoid colectomy using transanal specimen extraction (TASE).
• To evaluate the short-term outcomes of TASE in patients undergoing sigmoid colectomy.
• To assess the feasibility, safety, and oncological acceptability of this minimally invasive approach.

Main Methods:

• A prospective study of 18 patients undergoing totally laparoscopic sigmoid colectomy with TASE between April 2009 and July 2010.
• Specimen extraction was performed transanally using the Alexis® wound retractor after transection of the rectal stump.
• Rectal stump closure and colorectal anastomosis were completed using standard stapling techniques.

Main Results:

• Transanal specimen extraction was successful in 17 out of 18 cases; one case required conversion to conventional LAC due to specimen size.
• The median hospital stay was 6 days, with 16 cases (excluding combined cholecystectomy) having a mean operation time of 241 minutes.
• Complications included one case of anastomotic leakage and wound infection, and one case of enterocolitis. All patients remained disease-free with a mean Wexner score of 2.3 at 12 months.

Conclusions:

• Totally laparoscopic sigmoid colectomy utilizing transanal specimen extraction (TASE) with the Alexis® device is a feasible and safe procedure.
• The technique appears oncologically acceptable for selected patients, offering a potential reduction in wound complications associated with conventional LAC.
• Further evaluation of long-term outcomes and broader application in colorectal surgery is warranted.