Triluminal Hybrid NOS as a Novel Approach for Colonic Resection With Colorectal Anastomosis

Abstract

Tri-Port-NOS-SIG offers a feasible scarless approach for abdominal resections using commercially available surgical instruments in experienced hands.

Transanal extraction of the specimen during laparoscopic colectomy

“…The introduction of the anvil to the proximal section of colon is performed through both the anus and the abdominal wall. Most report the introduction of the anvil via the anus after distal resection, requiring the proximal segment to be reopened [1,3,10,18,19]. Some delivered the anvil by enlarging a port site [20].…”

Impact of body image on patients’ attitude towards conventional, minimal invasive, and natural orifice surgery

“…Acronyms like NOTES, NOS, hybrid-NOTES, and E-NOTES all describe surgical approaches with the main goal of reduced invasiveness and enhanced cosmesis. Similar to the experience with the introduction of laparoscopic operations into the surgical routine more than two decades ago, basic problems are reencountered in "no scar" surgery that have long been resolved for standard surgical approaches [12,13]. Many technical challenges have yet to be overcome and most procedures are not yet routine interventions [14,15].…”

Sashimi NOTES - extraction of bulky specimens in no-scar operations

“…For instance, hemicolectomies using single-port techniques and transvaginal hybrid-NOS techniques have been accomplished (8,(20)(21)(22)(23)(24). The authors have recently described scarless proctocolectomies with ileoanal pouch formation via a triluminal approach through natural orifices (9).…”

“…After dilation and placement of a circular protection foil (Alexis Wound Retractor, Applied Medical, Rancho Santa Margarita, CA, USA) a 25 mm Multi-port system (Tri-Port, Olympus Winter & Ibe GmbH, Hamburg, Germany) was placed and capnoperitoneum was established. Peritoneoscopy and subsequent sigmoid resection was perfomed as previously described (8,9). The specimen size was minimized by bowel-close mesenteric ultrasound dissection (Harmonic ACE, Ethicon-Endo Surgery, Inc., Cincinnati, OH, USA), yet, due to bulky and rigid specimen bowel invagination was not performed.…”

“…Continuous efforts have been made to address initial problems such as the establishment of new access sites, the creation of true triangulation through natural orifices and impaired intraoperative vision. This has led to the introduction of new instruments, port systems, cameras and the combination of two and more access sites (3,(6)(7)(8)(9). However, with growing experience the indications of "no scar" surgeries are extended and new challenges arise (1,10).…”