gms | German Medical Science

Einleitung: Although, in standard laparoscopy anterior resection can usually be performed using two five millimetres incisions and two twelve millimetre trocar (for insertion of the Endostapler), there remains the need for a minilaparotomy for specimen removal. The removal of the specimen through the vagina avoids a minilaparotomy and therefore additional harm to the abdominal wall. In our opinion the rigid hybrid-NOTES technique is the perfect tool to convert laparoscopically assisted operations into totally laparoscopic procedures.

Material und Methoden: In this instructive HD 3D video we present our technique of transvaginal hybrid-NOTES anterior resection in diverticular disease. The film combines intra- and extracorporal pictures, simultaneous taken during the operation in HD 3D quality with computer animations of each operation step.

Ergebnisse: After positioning of the patient the procedure is started with our standard medial mobilization of the left hemicolon. Afterwards the infrapancreatic ligation of the inferior mesenteric vein and the central ligation of the inferior mesenteric artery are performed using an energy device. The mobilization is completed from lateral. Afterwards the proximal rectum is preparated and dissected. The specimen is extracted through the vagina, followed by an extracorporal preparation of the decending meso and purse-string suture after insertion of the anvil in the oral colon. Afterwards, the vaginal wall is sutured. A circular stapler is inserted transanally and the end-to-end anastomosis is performed.

Schlussfolgerung: In our experience on more than 200 patients the transvaginal hybrid-NOTES anterior resections is a safe and feasible evolution of the standard laparoscopic procedure. The 3 D depth perception improves the accuracy and precision of surgical tasks.