Skip to main content

Advertisement

SpringerLink
Log in

MA-NOS radical sigmoidectomy: report of a transvaginal resection in the human

  • Technique
  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

With available laparoscopic and endoscopic instruments/technology a standard radical sigmoid resection is feasible and safe using transvaginal minilaparoscopic-assisted natural orifice surgery (MA-NOS).

Methods

The intervention was a transvaginal MA-NOS sigmoidectomy in a 78-year-old woman with a sigmoid adenocarcinoma. Maintaining triangulation the surgeon positioned himself at the right side of the patient and used the transvaginal trocar for dissection and stapling of both the inferior mesenteric vessels and the upper rectum. The colonic resection was performed extracorporeally in the conventional fashion and was followed by an intra-abdominal endoscopically assisted stapled anastomosis.

Results

Advantages of minimally invasive surgery seemed to be enhanced with this hybrid laparoscopic approach. Postoperative course was uneventful. All oncological principles governing resection and management were accomplished and the pathology examination confirmed a T3N1 lesion. The patient was discharged on the fourth postoperative day.

Conclusion

Transvaginal MA-NOS radical sigmoidectomy is a feasible and oncologically safe procedure. MA-NOS is a realistic option for avoiding the need of assisting incisions and related morbidity in the laparoscopic resection of large intra-abdominal lesions. Combined hybrid laparoscopic NOS in humans (MA-NOS) currently provides a safe and reliable way of defining future clinical applications and advantages of NOS and NOTES. Additionally, it stimulates the active development and evaluation of the underpinning technologies and instrumentation.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Reynolds W Jr (2001) The first laparoscopic cholecystectomy. JSLS 5(1):89–94

    PubMed  Google Scholar 

  2. Lacy AM, Delgado S, Castells A, Prins HA, Arroyo V, Ibarzabal A, Piqué JM (2008) The long-term results of a randomised clinical trial of laparoscopy assisted versus open surgery for colon cancer. Ann Surg (in press)

  3. Lacy AM, García-Valdecasas JC, Delgado S, Castells A, Taurá P, Piqué J, Visa J (2002) Laparoscopy-assisted colectomy versus open colectomy for treatment of non-metastatic colon cancer: a randomised trial. Lancet 359:2224–2229

    Article  PubMed  Google Scholar 

  4. The Clinical Outcome of Surgical Therapy (COST) Study Group (2004) A comparison of laparoscopically assisted and open colectomy for colon cancer. N Eng J Med 350:2050–2059

    Article  Google Scholar 

  5. Kalloo AN, Singh VK, Jagannath SB, Niiyama H, Hill SL, Vaughn CA, Magee CA, Kantsevoy S (2004) Flexible transgastric peritoneoscopy: a novel approach to diagnostic and therapeutic interventions in the peritoneal cavity. Gastrointest Endosc 60:114 –117

    Article  PubMed  Google Scholar 

  6. Kantsevoy SV, Jagannath SB, Niiyama H, Chung Sydney SC, Cotton PB, Gostout CJ, Hawes RH, Pasricha PJ, Magee CA, Vaughn CA, Barlow D, Shimonaka H, Kalloo AN (2005) Endoscopic gastrojejunostomy with survival in a porcine model. Gastrointest Endosc 62:287–292

    Article  PubMed  Google Scholar 

  7. Kantsevoy SV, Hu B, Jagannath SB, Vaughn CA, Beitler DM, Chung SSC, Cotton PB, Gostout CJ, Hawes RH, Pasricha J, Magee CA, Pipitone LJ, Talamini MA, Kalloo AN (2006) Transgastric endoscopic splenectomy: is it possible? Surg Endosc 20:522–525

    Article  PubMed  CAS  Google Scholar 

  8. Merrifield BF, Wagh MS, Thompson CC (2006) Peroral transgastric organ resection: a feasibility study in pigs. Gastrointest Endosc 63:693–697

    Article  PubMed  Google Scholar 

  9. Wagh MS, Merrifield BF, Thompson CC (2005) Endoscopic transgastric abdominal exploration and organ resection: initial experience in a porcine model. Clin Gastroenterol Hepatol 3:892–896

    Article  PubMed  Google Scholar 

  10. Pai RD, Fong DG, Bundga ME, Odze RD, Rattner DW, Thompson CC (2006) Transcolonic endoscopic cholecystectomy: a NOTES survival study in a porcine model (with video). Gastrointest Endosc 64:428–434

    Article  PubMed  Google Scholar 

  11. Pearl JP, Onders RP, Marks JM, Chak A, Mcgee MF, Rosen M, Ponsky JL (2007) Transgastric endoscopic peritoneoscopy in humans under laparoscopic visualization: a bridge to NOTES. Gastrointest Endosc 65:B292

    Article  Google Scholar 

  12. Gettman MT, Blute ML (2007) Transvesical peritoneoscopy: initial clinical evaluation of the bladder as a portal for natural orifice translumenal endoscopic surgery. Mayo Clin Proc 82:843– 845

    PubMed  Google Scholar 

  13. Ryou M, Fong DG, Pai RD (2007) NOTES distal pancreatectomy using endoscopic linear stapler. Gastroenterology 132:A114

    Google Scholar 

  14. Ghezzi F, Raio L, Mueller MD, Gyr T, Buttarelli M, Franchi M (2002) Vaginal extraction of pelvic masses following operative laparoscopy. Surg Endosc 16(12):1691–1696. doi:10.1007/s00464-002-9043-z, July 20, 2002

    Google Scholar 

  15. Whiteford MH, Denk PM, Swanstrom LL (2007) Feasibility of radical sigmoid colectomy performed as natural orifice translumenal endoscopic surgery (NOTES) using transanal endoscopic microsurgery. Surg Endosc 21:1870–1874

    Article  PubMed  CAS  Google Scholar 

  16. Young-Fadok TM, Whiteford MH, Denk PM, Swanstrom LL (2007) NOTES right colectomy: a feasibility study. Gastroenterology 132:A115

    Google Scholar 

  17. Della Flora E, Wilson TG, Martin IJ, O´Rourke NA, Maddern GJ (2008) A review of natural orifice translumenal endoscopic surgery (NOTES) for intra-abdominal surgery: experimental models, techniques, and applicability to the clinical setting. Ann Surg 247(4):583–602

    Article  Google Scholar 

  18. Rao GV (2006) Transgastric appendectomy results and follow up, SAGES transgastric surgery panel. Presented at SAGES Meeting

  19. Marescaux J, Dallemagne B, Perretta S, Wattiez A, Mutter D, Coumaros D (2007) Surgery without scars: report of transluminal cholecystectomy in a human being. Arch Surg 142(9):823–827

    Article  PubMed  Google Scholar 

  20. Bessler M, Stevens PD, Milone L (2007) Transvaginal laparoscopic cholecystectomy: laparoscopically assisted. SAGES Meeting. V029

  21. Zorron R, Soldan M, Costa M (2007) N.O.T.E.S. Transvaginal cholecystectomy—tips and challenges for human clinical application. VIII Congresso Brasileiro de Videocirurgia

  22. Tsin DA, Colombero LT, Lambeck J, Manolas P (2007) Minilaparoscopy-assisted natural orifice surgery. JSLS 11:24–29

    PubMed  Google Scholar 

  23. Voermans RP, Van Berge Henegouwen MI, Fockens P (2007) Natural orifice transluminal endoscopic surgery (NOTES). Endoscopy 39:1013–1017

    Article  PubMed  CAS  Google Scholar 

  24. Whiteford MH, Swanstrom LL (2007) Emerging technologies including robotics and Natural Orifice Transluminal Endoscopic Surgery (NOTES) colorectal surgery. J Surg Oncol 96:678–683

    Article  PubMed  Google Scholar 

  25. McGee MF, Rosen MJ, Marks J, Onders RP, Chak A, Faulx A, Chen VK, Ponsky J (2006) A primer on natural orifice transluminal endoscopic surgery: building a new paradigm. Surg Innov 13:86–93

    Article  PubMed  Google Scholar 

  26. Boni L, Benevento A, Rovera F, Dionigi G, Di Giuseppe M, Bertoglio C, Dionigi R (2006) Infective complications in laparoscopic surgery. Surg Infect (Larchmt) 7(suppl 2):S109–S111

    Google Scholar 

  27. Rattner D, Kalloo AN (2006) ASGE/SAGES Working group on Natural Orifice Translumenal Endoscopic Surgery October 2005, and the SAGES/ASGE working group on Natural Orifice Translumenal Endoscopic Surgery. White Paper. Surg Endosc 20:329–333

    Article  CAS  Google Scholar 

  28. Volckmann ET, Hungness ES, Soper NJ (2007) Patient perceptions of NOTES. SAGES Meeting. P033

Download references

Acknowledgement

The authors would like to thank Prof Sir Alfred Cuschieri for his helpful suggestions in writing this manuscript.

Author information

Authors and Affiliations

  1. Department of Gastrointestinal Surgery and Centro de Investigaciones Biomédicas Esther Koplowitz, Institut de Malalties Digestives I Metaboliques (IMDiM), IDIBAPS, Hospital Clínic, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain

    Antonio M. Lacy, Salvadora Delgado, Oscar A. Rojas & Raúl Almenara

  2. Department of Anaesthesiology and Centro de Investigaciones Biomédicas Esther Koplowitz, Institut de Malalties Digestives I Metaboliques (IMDiM), IDIBAPS, Hospital Clínic, University of Barcelona, Barcelona, Spain

    Anabel Blasi

  3. Department of Gastroenterology and Centro de Investigaciones Biomédicas Esther Koplowitz, Institut de Malalties Digestives I Metaboliques (IMDiM), IDIBAPS, Hospital Clínic, University of Barcelona, Barcelona, Spain

    Josep Llach

Authors
  1. Antonio M. Lacy
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Salvadora Delgado
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Oscar A. Rojas
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Raúl Almenara
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Anabel Blasi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Josep Llach
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Antonio M. Lacy.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Lacy, A.M., Delgado, S., Rojas, O.A. et al. MA-NOS radical sigmoidectomy: report of a transvaginal resection in the human. Surg Endosc 22, 1717–1723 (2008). https://doi.org/10.1007/s00464-008-9956-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-008-9956-2

Keywords

Search

Navigation