Hybrid NOTES colectomy for left-sided colorectal tumours: OP09

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Aim:In performing ‘conventional’ laparoscopic colectomy for left-sided colonic tumours, specimen retrieval necessitates a mini-laparotomy which often is the cause of postoperative pain, wound infection as well as other pain related complications. Herein we describe a new technique of laparoscopic colectomy with intra-corporeal colorectal anastomosis without mini-laparotomy for specimen retrieval.Method:This hybrid NOTES technique is applicable to patients with left side colorectal tumours < 4 cm in diameter and it involves insertion of the Transanal Endoscopic Operation (TEO) device in the lower rectum and for luminal extraction of the specimen via the opened rectal stump.Results:The technique was attempted in 24 patients (male: female 9:15) with median age of 68 years. Eight patients suffered from rectosigmoid tumours whereas fourteen patients had lesions in the sigmoid colon and two in descending colon. The median operating time was 109.5 min and the median blood loss was 20 ml. The median hospital stay was 6 days while the median maximum pain score was one during in-hospital stay in this series.Conclusions:Ourpreliminary experience indicates this hybrid approach is safe and feasible for selected patients with left-sided colonic tumours. Complications related to mini-laparotomy can be completely abolished.

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