FIRSTLY EXPERIENCE OF TRANSANAL AND TRANSVAGINAL NOTES FOR COLORECTAL CANCER

Abstract

Objective: Natural Orifice Transluminal Endoscopic Surgery (NOTES) is an important variation in minimally invasive surgery (MIS) nowaday. We would like to present the techniques and the results of the pure transanal and transvaginal laparoscopies (NOTES) in treatment of colorectal cancer. Material and method: Prospective study at Hue Central Hospital, Vietnam. Patients: From December 2013 to December 2015, 22 cololorectal cancers (17 rectum, 4 sigmoid tumors and 1 descending colon), adenocarcinoma, T≤ T3N1M0. Methods: The patients were placed in the lithotomy and Trendelenburg position, and the lone-star retractor was placed in anus (rectum cancer) or vagina (sigmoid cancer). Inflating of surgical cavity with CO2 and setting at 12 mmHg. Continuing dissection until go inside of the abdominal cavity (transanal technique), after that, the rectum was pushed into the abdominal cavity. The IMA, IMV were divided (TME included) in both techniques. After finishing dissection, specimens were pulled out through the anus or vagina to prepare anastomosis. The coloanal or colorectal anastomosis was performed by hand-sewn (6 cases) or by EEA staplers (16 cases). Results: 3 patients needed one more 5 mm umbilical port in RLQ, 1 patient needed two 5mm trocars (post radiation hemorrhagy, urethral perforation,…). 1 patient converted to open and 1 patient converted to HYBRID-NOTES procedure. The operation time was 258 ± 40 (190 - 300). All patients required minimal analgesia. Bowel movement returned on the first day in 16 patients (average: 2 days, maximum: 3 days). The hospital stay was 8 ± 2,6 (4 -14 days). Kirwan clasification (sphinter function) is very good (stage I: 16). Conclusions: Pure transanal and transvaginal laparoscopies in treatment of colorectal cancer are feasible and safe. It seems to be the first pure transvaginal laparoscopy (NOTES) for human in the world. However, a multicentric studies and long follow-up are necessary. Key words: Natural Orifice Transluminal Endoscopic Surgery (NOTES), colorectal cancer, Pure transanal