Minimal invasive surgery: NOSE and NOTES in ulcerative colitis.

Area of Science:

• Gastroenterology
• Surgical Innovation
• Colorectal Surgery

Background:

• Laparoscopic pelvic dissection for ulcerative colitis (UC) with ileal pouch-anal anastomosis (IPAA) can be challenging, often requiring hand-assistance and increasing operative times.
• Emerging hybrid Natural Orifice Surgery (NOS) and Natural Orifice Transluminal Endoscopic Surgery (NOTES) approaches offer potential advantages over conventional laparoscopy.
• A novel hybrid approach aims to simplify proctectomy, avoid additional incisions, and reduce surgical duration in UC patients undergoing IPAA.

Purpose of the Study:

• To evaluate the short-term outcomes of a novel hybrid transanal and laparoscopic approach for IPAA in patients with UC.
• To assess the feasibility and safety of a "down-to-up" proctectomy technique combined with transanal dissection.
• To determine the impact of this hybrid technique on operative times, hospital stay, and functional outcomes.

Main Methods:

• A single-arm prospective study enrolled UC patients requiring IPAA between July 2011 and March 2014.
• A three-step procedure was performed: laparoscopic colectomy with transanal colon removal, followed by a "down-to-up" transanal proctectomy and IPAA, and finally ileostomy closure.
• Functional outcomes, including defecation frequency and continence scores (Oresland, Wexner), were assessed three months post-procedure.

Main Results:

• Sixteen patients completed all surgical stages, with a mean operative time of 162.2 minutes for the first step and 170 minutes for the second.
• The median hospital stay was 6 days for the first step and 5.5 days for the second, with no major complications reported.
• Functional outcomes showed a mean defecation frequency of 5.5 times per day, with 75% of patients able to retain stools. Mean Oresland score was 4.7 and Wexner score was 1.4.

Conclusions:

• The hybrid transanal and laparoscopic technique is a safe and feasible option for treating UC patients requiring IPAA.
• Short-term functional outcomes are promising, suggesting potential benefits in terms of reduced invasiveness and operative time.
• Further long-term outcome data and controlled trials are necessary to validate these findings and establish the technique's definitive role in UC management.