Totally Laparoscopic Sigmoidectomy with Transrectal Specimen Extraction

Background. Totally laparoscopic colectomy with natural orifice specimen extraction (NOSE) has been reported with great interest. We attempt to evaluate the feasibility of this technique for totally laparoscopic sigmoidectomy with NOSE and report immediate postoperative outcomes in patients with sigmoid colon cancer. Methods. Patients with sigmoid cancer were selected depending on the size of the tumor and its distance from the anal verge. Demographic data, operative parameters, and postoperative outcomes were assessed. After complete resection of the tumor, all patients underwent an intracorporeal colorectal anastomosis following transrectal specimen extraction. Results. Laparoscopic resection with our technique of intracorporeal anastomosis was successful in 33 patients. The average operative time was 191 ± 28 min and mean blood loss was 53 ± 18 cc. All patients experienced mild postoperative pain and the bowel function returned before POD 3 in most patients. They had an uneventful postoperative course with a median hospital stay of 6 days. Major perioperative complications or anastomotic leak were not encountered in this study. The mean size of the lesion was 3.6 ± 1.0 cm and the mean number of harvested nodes was 13 ± 6. During the follow-up period, there were no functional disorders associated with the intracorporeal anastomosis or transrectal specimen extraction. Conclusion. Totally laparoscopic colorectal surgery is a safe and effective procedure for patients with sigmoid colon malignancy.