Clinical Trials Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Sep 10, 2015; 7(12): 1078-1082
Published online Sep 10, 2015. doi: 10.4253/wjge.v7.i12.1078
Laparoscopic right-sided colonic resection with transluminal colonoscopic specimen extraction
Cuneyt Kayaalp, Koray Kutluturk, Mehmet Ali Yagci, Mustafa Ates
Cuneyt Kayaalp, Mehmet Ali Yagci, Department of Gastrointestinal Surgery, Inonu University, 44280 Malatya, Turkey
Koray Kutluturk, Mustafa Ates, Department of Surgery, Inonu University, 44280 Malatya, Turkey
Author contributions: Kayaalp C designed research; Kayaalp C, Kutluturk K, Yagci MA, Ates M performed research; Kayaalp C contributed to new reagents or analytic tools; Kayaalp C and Yagci MA analyzed data; Kayaalp C and Kutluturk K wrote the paper.
Institutional review board statement: The study was reviewed and approved by Inonu University Institutional Review Board.
Clinical trial registration statement: This study is registered at Inonu University Human Ethical Committee as a research. The registration identification number is 2014/33.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All the authors declare no conflict-of-interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Cuneyt Kayaalp, MD, Professor, Department of Gastrointestinal Surgery, Inonu University, Elazig yolu 10. km, 44280 Malatya, Turkey. cuneytkayaalp@hotmail.com
Telephone: +90-422-3410660 Fax: +90-422-3410229
Received: September 18, 2014
Peer-review started: September 18, 2014
First decision: December 17, 2014
Revised: June 9, 2015
Accepted: July 7, 2015
Article in press: August 24, 2015
Published online: September 10, 2015
Abstract

AIM: To study the transcolonic extraction of the proximally resected colonic specimens by colonoscopic assistance at laparoscopic colonic surgery.

METHODS: The diagnoses of our patients were Crohn’s disease, carcinoid of appendix and adenocarcinoma of cecum. We preferred laparoscopic total mesocolic resections. Colon and terminal ileum were divided with endoscopic staplers. A colonoscope was placed per anal and moved proximally in the colon till to reach the colonic closed end under the laparoscopic guidance. The stump of the colon was opened with laparoscopic scissors. A snare of colonoscope was released and the intraperitoneal complete free colonic specimen was grasped. Specimen was moved in to the colon with the help of the laparoscopic graspers and pulled gently through the large bowel and extracted through the anus. The open end of the colon was closed again and the ileal limb and the colon were anastomosed intracorporeally with a 60-mm laparoscopic stapler. The common enterotomy orifice was closed in two layers with a running intracorporeal suture.

RESULTS: There were three patients with laparoscopic right-sided colonic resections and their specimens were intended to remove through the remnant colon by colonoscopy but the procedure failed in one patient (adenocarcinoma) due to a bulky mass and the specimen extraction was converted to transvaginal route. All the patients had prior abdominal surgeries and had related adhesions. The operating times were 210, 300 and 500 min. The lengths of the specimens were 13, 17 and 27 cm. In our cases, there were no superficial or deep surgical site infections or any other complications. The patients were discharged uneventfully within 4-5 d and they were asymptomatic after a mean 7.6 mo follow-up (ranged 4-12). As far as we know, there were only 12 cases reported yet on transcolonic extraction of the proximal colonic specimens by colonoscopic assistance after laparoscopic resections. With our cases, success rate of the overall experience in the literature was 80% (12/15) in selected cases.

CONCLUSION: Transcolonic specimen extraction for right-sided colonic resection is feasible in selected patients. Both natural orifice surgery and intracorporeal anastomosis avoids mini-laparotomy for specimen extraction or anastomosis.

Keywords: Colonoscopy, Colon cancer, Crohn’s disease, Laparoscopic surgery, Natural orifice transendoscopic surger, Natural orifice specimen extraction

Core tip: Transcolonic extraction of the proximally resected colonic specimens by colonoscopic assistance can be an attractive method for some selected cases. This technique requires both advanced laparoscopic experience by intracorporeal anastomosis and interventional endoscopy. In this technique, there was a far distance between the resected specimen and the natural orifice. The specimen is moved about 100 cm in a hollow organ till the natural orifice. As far as we know, it has been the farthest distance that was reported yet for natural orifice specimen extractions. However, this technique is only suitable for small specimens which can pass through the sigmoid colon.