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Metzger U, Michel AJ, Ardelean MA, Metzger RP. Transanal Endoscopic-Assisted Pull-Through Colectomy for Children with High Intestinal Aganglionosis. CHILDREN 2022; 9:children9050588. [PMID: 35626766 PMCID: PMC9139831 DOI: 10.3390/children9050588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 03/28/2022] [Accepted: 03/31/2022] [Indexed: 11/23/2022]
Abstract
Intestinal aganglionosis in children is a common cause of neonatal and infantile obstruction or ileus. Diagnosis is based on a histologically proven absence of enteric ganglion cells in deep biopsies of the gut wall. Therapeutic goal is a one-stage repair with a resection of the affected segment. The endorectal pull-through (ERP) can be performed entirely transanally in a lot of the cases. In patients with difficult preparation or a high aganglionosis ERP often needs to be assisted by laparoscopy or laparotomy. We present two cases with a technical modification performing a totally transanal pull-through colectomy without any trocars other than an umbilical camera trocar. The procedure starts with a classical endorectal technique. Usually, the transanal preparation is limited by reaching the colon descendens. A camera trocar is inserted and under laparoscopic vision the preparation is completed placing the instruments directly via the opened anus. After reaching the healthy colon segment, the pull-through is completed transanally. One of the main advantages of ERP is the sparing dissection. Our modification combines advantages of laparoscopy and ERP. The umbilical camera allows an excellent view while the instruments for dissection are used like with ERP without any further trocar or traction of the anal sphincter. The dispensation of any transanal trocar allows a higher grade of freedom in preparation and possibly a smaller trauma on the distal anal channel.
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Watanabe T, Mori M, Shimizu T, Yamamoto Y, Tei E, Hirakawa H, Ohno M, Tahara K, Tomonaga K, Ogawa K, Takezoe T, Fuchimoto Y, Fujino A, Kanamori Y. Intraluminal manipulator-assisted laparoscopic surgery for Hirschsprung disease. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2020. [DOI: 10.1016/j.epsc.2020.101606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Metzger R. Morbus Hirschsprung. Monatsschr Kinderheilkd 2017. [DOI: 10.1007/s00112-017-0250-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Xia X, Li N, Wei J, Zhang W, Yu D, Zhu T, Feng J. Single-incision laparoscopic versus conventional laparoscopic surgery for Hirschsprung's disease: A comparison of medium-term outcomes. J Pediatr Surg 2016; 51:440-3. [PMID: 26611332 DOI: 10.1016/j.jpedsurg.2015.10.051] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Revised: 10/13/2015] [Accepted: 10/13/2015] [Indexed: 12/11/2022]
Abstract
INTRODUCTION This study aims to report medium-term outcomes of single-incision laparoscopic surgery (SILS) and compare its results with conventional laparoscopic surgery (CLS). PATIENTS AND METHODS Seventy-five patients with Hirschsprung's disease (HD) underwent operations from January 2009 to December 2012 in our institution (SILS, n=40; CLS, n=35). SILS procedure is similar to CLS, but uses a single, 1.5-cm horizontal skin incision in the umbilicus for laparoscopic access. Operative characteristics and medium-term outcomes were assessed. RESULTS On average, patients in the SILS group had shorter operative times (mean±standard deviation, 226±69.4min) than those in the CLS group (268.9±83.6min) (P=0.01). Fourteen cases (35%) in the SILS group and ten cases (28.6%) in the CLS group had extended HD. Medium-term outcomes did not significantly differ between the groups, and the SILS group had better cosmetic results. CONCLUSIONS SILS could be safely performed in HD patients with good medium-term outcomes. Although SILS and CLS procedures had similar medium-term outcomes, SILS has advantages such as better cosmetic results and shorter operative times.
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Affiliation(s)
- Xue Xia
- Department of Pediatric Surgery, Tongji Hospital, 1095 Jiefang Avenue, Wuhan 430030, China.
| | - Ning Li
- Department of Pediatric Surgery, Tongji Hospital, 1095 Jiefang Avenue, Wuhan 430030, China
| | - Jia Wei
- Department of Pediatric Surgery, Tongji Hospital, 1095 Jiefang Avenue, Wuhan 430030, China
| | - Wen Zhang
- Department of Pediatric Surgery, Tongji Hospital, 1095 Jiefang Avenue, Wuhan 430030, China
| | - Donghai Yu
- Department of Pediatric Surgery, Tongji Hospital, 1095 Jiefang Avenue, Wuhan 430030, China
| | - Tianqi Zhu
- Department of Pediatric Surgery, Tongji Hospital, 1095 Jiefang Avenue, Wuhan 430030, China
| | - Jiexiong Feng
- Department of Pediatric Surgery, Tongji Hospital, 1095 Jiefang Avenue, Wuhan 430030, China.
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Lee GC, Sylla P. Shifting Paradigms in Minimally Invasive Surgery: Applications of Transanal Natural Orifice Transluminal Endoscopic Surgery in Colorectal Surgery. Clin Colon Rectal Surg 2015; 28:181-93. [PMID: 26491411 DOI: 10.1055/s-0035-1555009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Since the advent of laparoscopy, minimally invasive techniques such as single port laparoscopy, robotics, endoscopically assisted laparoscopy, and transanal endoscopic surgery continue to revolutionize the field of colorectal surgery. Transanal natural orifice transluminal endoscopic surgery (NOTES) represents a further paradigm shift by combining the advantages of these earlier techniques to reduce the size and number of abdominal incisions and potentially optimize rectal dissection, especially with respect to performance of an oncologically adequate total mesorectal excision (TME) for rectal cancer. Since the first experimental report of transanal rectosigmoid resection in 2007, the potential impact of transanal NOTES in colorectal surgery has been extensively investigated in experimental models and recently transitioned to clinical application. There have been 14 clinical trials of transanal TME (taTME) for rectal cancer that have demonstrated the feasibility and preliminary oncologic safety of this approach in carefully selected patients, with results comparable to outcomes after laparoscopic and open TME, including cumulative intraoperative and postoperative complication rates of 5.5 and 35.5%, respectively, 97.3% rate of complete or near-complete specimens, and 93.6% rate of negative margins. Transanal NOTES has also been safely applied to proctectomy and colectomy for benign indications. The consensus among published series suggests that taTME is most safely performed with transabdominal assistance by surgeons experienced with laparoscopic TME, transanal endoscopic surgery, and sphincter-preserving techniques including intersphincteric resection. Future applications of transanal NOTES may include evolution to a pure endoscopic transanal approach for TME, colectomy, and sentinel lymph node biopsy for rectal cancer, with a potential role for robotic assistance.
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Affiliation(s)
- Grace Clara Lee
- Division of Gastrointestinal Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Patricia Sylla
- Division of Gastrointestinal Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
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Vahdad MR, Cernaianu G, Semaan A, Klein T, Faran S, Zemon H, Boemers T, Foroutan HR. An experimental study in six fresh human cadavers using a novel approach to avoid abdominal wall incisions in total colectomy: totally transanal laparoendoscopic single-site pull-through colectomy with J-pouch creation. Surg Endosc 2015; 30:3107-13. [PMID: 26487229 DOI: 10.1007/s00464-015-4555-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Accepted: 09/03/2015] [Indexed: 01/26/2023]
Abstract
BACKGROUND The use of transanal laparoscopic access to completely avoid abdominal wall incisions represents the most current evolution in minimally invasive surgery. The combination of single-site surgery and natural orifice transluminal endoscopic surgery (NOTES™) can be used for totally transanal laparoendoscopic pull-through colectomy with J-pouch creation (TLPC-J). The aim of the present study was to provide evidence for the feasibility of TLPC-J in adult human cadavers. METHODS TLPC-J was performed in six fresh adult human cadavers. The procedure involved endorectal submucosal dissection from 1 cm above the dentate line to a point above the peritoneal reflection, where the rectal muscle was divided circumferentially. The edge of the mucosal cuff was closed distally in order to prevent fecal contamination and the endorectal tube was placed back into the abdomen. A Triport+™ or QuadPort+™ system was introduced transanally, and it served as a multiport device (MD). Resection of the entire colon, mobilization of the distal ileal segment, and extracorporeal suture of the ileal J-loop were performed via the transanal approach. The J-pouch was created using Endo GIA™. After removal of the MD, the J-pouch was sutured to the rectal wall. RESULTS TLPC-J was performed in all cadavers, with a mean operation duration of 236 ± 22 min. Conversion to either transabdominal laparoscopy or laparotomy was not required in any of the cadavers. No bowel perforation or damage to other organs was observed. The use of a curved endoscope greatly facilitated visualization during transanal laparoscopic dissection for partial and total colectomy, making the procedure feasible. All specimens were retrieved through the anus, eliminating the need for additional transabdominal incisions. CONCLUSIONS TLPC-J was technically feasible in adult human cadavers, and abdominal wall incisions were not required. However, clinical studies are needed to determine its feasibility in living adults.
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Affiliation(s)
- M Reza Vahdad
- Department of Pediatric Surgery and Pediatric Urology, Kliniken der Stadt Köln gGmbH, Kinderkrankenhaus Amsterdamer Strasse 59, 50735, Cologne, Germany.
| | - Grigore Cernaianu
- Department of Pediatric Surgery, University Hospital Cologne, Kerpenerstr. 62, 50937, Cologne, Germany
| | - Alexander Semaan
- Department of Pediatric Surgery and Pediatric Urology, Kliniken der Stadt Köln gGmbH, Kinderkrankenhaus Amsterdamer Strasse 59, 50735, Cologne, Germany
| | - Tobias Klein
- Department of Pediatric Surgery and Pediatric Urology, Kliniken der Stadt Köln gGmbH, Kinderkrankenhaus Amsterdamer Strasse 59, 50735, Cologne, Germany
| | - Samuel Faran
- Olympus Surgical Technologies Europe, Kuehnstraße 61, 22045, Hamburg, Germany
| | - Harry Zemon
- White Plains Hospital, 210 Westchester Avenue, White Plains, NY, 10604, USA
| | - Thomas Boemers
- Department of Pediatric Surgery and Pediatric Urology, Kliniken der Stadt Köln gGmbH, Kinderkrankenhaus Amsterdamer Strasse 59, 50735, Cologne, Germany
| | - Hamid Reza Foroutan
- Department of Pediatric Surgery, Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, 7141995377, Iran
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Vahdad MR, Rahmanian E, Moslemi S, Najafi SM, Foroutan HR. Totally Transanal Laparo-Endoscopic Single-Site ProctoColectomy-Ileoanal J-Pouch (TLPC-J): An Experimental Study of a Novel Approach. IRANIAN JOURNAL OF MEDICAL SCIENCES 2015; 40:425-9. [PMID: 26379349 PMCID: PMC4567602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/06/2014] [Revised: 03/26/2014] [Accepted: 04/28/2014] [Indexed: 10/31/2022]
Abstract
BACKGROUND The natural orifice transluminal endoscopic surgery (NOTES) has become a commonly considered novel approach in the surgical field. The NOTES provide possibility of operation through the natural orifice and decreases the intentional puncture of the systemic organ and subsequent complications. Totally transanal laparo-endoscopic single-site proctoColectomy-Ileoanal J-Pouch (TLPC-J) is a novel method in minimally invasive surgery for total colectomy. The main goal of this study is to perform this new method on an animal model, to assess probable complication and to resolve probable issues by using patients that are candidate for total colectomy. METHOD Five dogs were prepared in lithotomy position. The TLPC-I procedure consists of endorectal technique with full thickness rectal dissection starting 1 cm orally from the dentate line above the peritoneal reflection and the proximal bowel was replaced into the abdominal cavity. Afterwards, the TriPort system was inserted in the anal canal and mesentrial resection of the total colon, mobilization of a distal ileal segment and intracorporeal suture of an ileal J-loop was accomplished by this system. An incision in the J-loop was conducted transanally. The J-pouch was created with an Endo-GIA® and sutured to the rectal wall. RESULTS All animals survived and passed stool with clear post operation situation. There was no infection in site of anastomosis. CONCLUSION The TLPC-I provides the possibility of surgery without abdominal wall incision and decreases post operation complication such as pain, abdominal wound infection and wound dehiscence. This technique increases the quality of life and surgeons can discharge the patients early.
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Affiliation(s)
- Mohammad Reza Vahdad
- Department of Pediatric Surgery, Catholic Foundation Marienhospital Herne, Ruhr-University of Bochum, Herne, Germany
| | - Ehsan Rahmanian
- Department of General Surgery, Shahid Faghihi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sam Moslemi
- Colorectal Research Center, Shahid Faghihi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sultan Mohsen Najafi
- Department of Pediatric Surgery, Namazi Hospital, Shiraz University Laparoscopy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hamid Reza Foroutan
- Department of Pediatric Surgery, Namazi Hospital, Shiraz University Laparoscopy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran,Correspondence: Hamid Reza Foroutan, MD; Department of Pediatric Surgery, Shiraz University Laparoscopy Research Center, Namazi Hospital, P.O. Box 7141995377, Shiraz, Iran Tel: +98 71 36279622 Fax: +98 71 32279721
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Aubdoollah TH, Li K, Zhang X, Li S, Yang L, Lei HY, Dolo PR, Xiang XC, Cao GQ, Wang GB, Tang ST. Clinical outcomes and ergonomics analysis of three laparoscopic techniques for Hirschsprung's disease. World J Gastroenterol 2015; 21:8903-8911. [PMID: 26269680 PMCID: PMC4528033 DOI: 10.3748/wjg.v21.i29.8903] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2014] [Revised: 03/13/2015] [Accepted: 05/19/2015] [Indexed: 02/07/2023] Open
Abstract
AIM: To report the clinical outcomes and ergonomics analysis of three laparoscopic approaches in the management of Hirschsprung’s disease (HD).
METHODS: There were 90 pediatric patients (63 boys, 27 girls; mean age: 3.6 ± 2.7 mo; range: 1.0-90.2 mo) who underwent laparoscopic endorectal pull-through Soave procedures for short- and long-segment HD in our hospital. Three laparoscopic approaches were used: conventional laparoscopic pull-through (CLP) in 30 patients between 2009 and 2013, single-incision laparoscopic pull-through (SILP) in 28 patients between 2010 and 2013, and hybrid single-incision laparoscopic pull-through (H-SILP) in 32 patients between 2011 and 2013. We applied the hybrid version of the single-incision approach in 2011 to preserve the cosmetic advantage of SILP and the ergonomic advantage of CLP. We retrospectively analyzed the clinical data, cosmetic results, and ergonomics of these three approaches to have a better understanding of the selection of one approach over another.
RESULTS: The CLP, SILP, and H-SILP groups were similar in regard to age, sex, transition zone, blood loss, hospital stay, and intraoperative complications. Early and late postoperative results were not different, with equal daily defecation frequency and postoperative complications. No conversion to open technique was needed and none of the patients had recurrent constipation. With proper training, the ergonomics challenges were overcome and similar operative times were registered for the general operative time in the patients < 1 year of age and the short-segment HD patients. However, significantly shorter operative times were registered compared to SILP for patients > 1 year of age (CLP and H-SILP: 120 ± 15 min and 119 ± 12 min, respectively, vs 140 ± 7 min; P < 0.05) and for long-segment HD patients (152 ± 3.5 min and 154 ± 3.6 min, respectively, vs 176 ± 2.3 min; P < 0.05). The best cosmetic result was registered with the SILP (scarless), followed by the H-SILP (near scarless appearance) and the CLP (visible scars) procedures.
CONCLUSION: Based on the results, we believed that the laparoscopic approach should be selected according to the age, transition zone, and desired cosmetic result.
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Aubdoollah TH, Tang ST, Yang L, Li S, Lei HY, Zhang X. Hybrid Single-Incision Laparoscopic Approaches for Endorectal Pull-Through in Hirschsprung's Disease. J Laparoendosc Adv Surg Tech A 2015; 25:595-8. [PMID: 25594866 DOI: 10.1089/lap.2014.0343] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Transanal endorectal pull-through for Hirschsprung's disease (HD) is a relatively safe and feasible procedure in neonates and infants. However, overstretching on the anal sphincter and mesentery of the sigmoid colon might cause potential risk of impaired defecation function. Single-incision laparoscopic endorectal pull-through (SILEP) is technically feasible and safe in HD patients, offering a better cosmetic result. However, it is stressful for the surgeon in view of its low manipulability and poor visualization causing clashing of instruments, especially in older children or patients with long-segment aganglionosis. We developed an age- and type-appropriate technique of hybrid SILEP (H-SILEP) using a trocarless instrument via another abdominal stab incision to obtain further improvement of SILEP in selected HD patients. PATIENTS AND METHODS Between August 2010 and July 2013, 36 patients (24 boys and 12 girls, with a mean age of 3.9 months) with HD underwent H-SILEP. Patient age, gender, transitional zone, operative time, blood loss, and intraoperative and postoperative complications, as well as short- and long-term results, were assessed. RESULTS Ten patients had transitional zone in the rectum, 17 patients in the sigmoid colon, and 9 patients in the descending colon. Neither additional ports nor conversion to laparotomy was required in these 36 patients. The mean operative time was 116 minutes. There was no major intraoperative complication. Perianal excoriation was the main early postoperative complication, which occurred in 9 patients. No anastomotic leak occurred. Postoperative enterocolitis occurred in 2 patients. There was no recurrent constipation. Follow-up for 6 months to 3 years in all patients showed an excellent cosmetic result. CONCLUSIONS Our procedure is feasible and safe, and it is technically less challenging to perform H-SILEP in selected HD patients. Moreover, it is better to use additional instruments for ergonometric reasons.
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Affiliation(s)
- Tajammool Hussein Aubdoollah
- Department of Pediatric Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology , Wuhan, China
| | - Shao-Tao Tang
- Department of Pediatric Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology , Wuhan, China
| | - Li Yang
- Department of Pediatric Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology , Wuhan, China
| | - Shuai Li
- Department of Pediatric Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology , Wuhan, China
| | - Hai-Yan Lei
- Department of Pediatric Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology , Wuhan, China
| | - Xi Zhang
- Department of Pediatric Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology , Wuhan, China
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