Transvaginal rigid-hybrid natural orifice transluminal endoscopic surgery technique for anterior resection treatment of XXXX : a feasibility study.

@entity1 @entity66 @entity548 @entity532 @entity1003 @entity1578 @entity733 @entity4436 @entity516 @entity298
BACKGROUND: In laparoscopic anterior resection, minilaparotomy still is required. Recently, transvaginal hybrid natural orifice transluminal endoscopic surgery (NOTES) techniques for cholecystectomy have been described. Reports on operations that require removal of larger specimens, as in anterior resection, are scarce and limited primarily to small case series and case reports. The current study aimed to evaluate the feasibility and safety of transvaginal rigid-hybrid NOTES anterior resection (tvAR) for symptomatic @entity66 . METHODS: All female @entity1 presenting with symptomatic @entity4436 of the sigmoid colon were candidates for inclusion in the study. The exclusion criteria specified failure to sign informed consent, previous colorectal resection, anesthesiologic contraindication for @entity516 , @entity1578 and @entity1003 , severe acute @entity548 , internal fistula with @entity733 (Hinchey 2b), @entity4436 with @entity298 (Hinchey 3 or 4), gynecologic or urologic contraindications, and absence of preoperative gynecologic examination. A preoperative and 2-week postoperative gynecologic examination was performed. Quality of life and sexual function were assessed preoperatively and 6  weeks postoperatively. RESULTS: Of 70 @entity1 , 45 (64.3%) were scheduled for tvAR. Five @entity1 were withdrawn at the beginning of laparoscopy with no transvaginal access performed. Of the remaining 40 @entity1 with attempted tvAR, 4 @entity1 underwent conversion to a minilaparotomy (Pfannenstiel incision) and 2 @entity1 were converted to a total median laparotomy. For 34 @entity1 (85%), the operation was completed transvaginally. @entity532 and 10 minor complications occurred. No serious postoperative gynecologic morbidity was experienced. At 6  weeks postoperatively, sexual function did not differ significantly from preoperative status. CONCLUSIONS: For symptomatic @entity66 , TvAR is feasible, although the presented technique requires laparoscopic expertise and further refinement.
