Endo-laparoscopic colectomy without mini-laparotomy for left-sided colonic tumors.

BACKGROUND: In performing "traditional" laparoscopic colectomy for left-sided colonic tumors, specimen retrieval necessitates a mini-laparotomy which often is the cause of postoperative pain, wound infection, and other pain-related complications. Here we describe a new technique of endo-laparoscopic anterior resection without mini-laparotomy, where specimen retrieval and colorectal anastomosis can be safely achieved with the use of the transanal endoscopic operation (TEO) device set-up. METHODS: This hybrid natural orifice transluminal endoscopic surgery (NOTES) technique involves insertion of the TEO device in the lower rectum and luminal extraction of the specimen via the device. The technique is applicable to patients with small tumors (4 cm or less) in the left-sided colon or upper rectum, where transanal construction of a stapled colorectal anastomosis is intended. RESULTS: The technique was attempted in ten patients (male:female 4:6) with median age of 66 years (range: 55-81 years). Five patients suffered from rectosigmoid tumors, whereas four patients had lesions in the sigmoid colon and one had a lesion in the descending colon. The median operating time was 127.5 min (range: 105-170 min) and the median blood loss was 20 ml (range: 20-50 ml). The median hospital stay was 7 days (range: 4-18 days), while the median maximum pain score (visual analog score) was 2 (range: 2-3) during in-hospital stay in this small series. CONCLUSIONS: Our preliminary experience indicates this new technique of endo-laparoscopic colectomy is feasible for selected patients with left-sided colonic tumors. Complications related to mini-laparotomy can be abolished entirely with this hybrid approach.

Combined endolaparoscopic intragastric excision for gastric neoplasms.

BACKGROUND: The aim of this study was to describe our technique of combined endolaparoscopic approach to the management of intraluminal gastric neoplasms and to review the clinical outcome. METHODS: Between February 2006 and January 2008, a total of 12 patients with gastric neoplasm < or =4 cm with a mainly intraluminal component received the combined endolaparoscopic intragastric excision and were prospectively analyzed. All lesions were localized endoscopically and then treated by using a combined endoscopic submucosal dissection and laparoscopic intragastric technique. RESULTS: Eight of 12 lesions were gastrointestinal stromal tumours. The remaining lesions were adenomatous polyp with focal intramucosal adenocarcinoma, leiomyoma, and pancreatic heterotopia. All except 1 case was successfully treated with this technique (91.6%). There were no mortalities, and there was only 1 case of reactionary hemorrhage from the port site requiring a reoperation. The median operating time was 120 minutes, with a median blood loss of 35 mL. Length of hospital stay ranged from 3 to 12 days. There were no recurrences during the follow-up period. CONCLUSIONS: This combined endolaparoscopic intragastric excision technique is a truly minimally invasive alternative for selected gastric neoplasm. It is safe and feasible with a satisfactory short-term outcome.