Transanal hybrid colon resection: from laparoscopy to NOTES

Area of Science:

• Minimally invasive surgery
• Colorectal surgery
• Natural orifice transluminal endoscopic surgery (NOTES)

Background:

• Reducing access size and trauma are key challenges in minimally invasive endoscopic surgery.
• The transanal approach, combining laparoscopic colorectal surgery and transanal endoscopic microsurgery expertise, offers a viable option for NOTES.
• This technique facilitates the introduction of transanal hybrid laparoscopic-assisted colon resection into clinical practice.

Purpose of the Study:

• To assess the feasibility and patient safety of the clinical introduction of transanal hybrid colon resection.
• To evaluate the effectiveness of a novel hybrid NOTES technique for colon resection.

Main Methods:

• Prospective study of patients with pelvic floor disorders, prolapse, and slow-transit constipation requiring colon resection.
• Utilized a hybrid approach with reduced port size (camera and two 5-mm ports) via a transanal route for complex tasks.
• Tasks included stapler anvil positioning, resection, specimen retrieval, anastomosis, and bowel closure.

Main Results:

• Fifteen patients (all women, mean age 61) underwent transanal hybrid colon resection; 11 had additional rectopexy.
• One conversion to full laparoscopy and one complication (bleeding, no reintervention) were recorded.
• Mean procedure time was 131 minutes; Gastrointestinal Quality of Life Index improved from 96 to 117 post-surgery.

Conclusions:

• Transanal hybrid colon resection is a feasible and safe hybrid NOTES procedure.
• This technique can be effectively integrated into clinical practice for selected colorectal conditions.
• The study highlights the potential of transanal approaches to advance minimally invasive surgery.