Incisionless Laparoscopic Colectomy for Colorectal Cancer “Hybrid NOTES Technique Applied to Traditional Laparoscopic Colorectal Resection”

Background: We recently developed a new technique of laparoscopic colectomy (LAC) for colorectal cancer. This procedure, called “Incisionless LAC (iLAC)”, involves completely laparoscopic double stapling technique (DST) without mini-laparotomy. Methods: This technique was applied in the cases with relatively early-stage cancer of the sigmoid colon or rectum. The procedure involved 5 ports. Lymph node dissection and mobilization of the bowel were carried out completely via a laparoscope. The specimen was extracted through the original anus. Anastomosis was laparoscopically performed with DST. Method A: The proximal and distal parts of the lesion are transected with laparoscopic staplers. The staple at the upper rectum is released, and the lesion is removed out of the body through the anus. The anvil is attached to the proximal part of the bowel laparoscopically, followed by intracorporeal side-to-end anastomosis with DST. Method B: The proximal part of the lesion is transected with laparoscopic staplers. Then, the lesion and bowel are pulled out of the body through the anus by means of inversion, followed by transection of the distal side of the bowel with a stapler. The distal side of the bowel is pushed back into the body, and the anvil is attached to the proximal part of the bowel laparoscopically. Then, intr acorporeal anastomosis with DST is performed. Results: Method A was applied in eight cases. Method B was applied in twelve cases. Postoperative complications developed in none of the cases. Although the postoperative follow-up period to date is still short, no tumor recurrence in the stump has occurred in any of the cases. Conclusion: Our experience indicates this “iLAC” technique is feasible for selected patients with left-sided colonic tumors. Complications related to mini-laparotomy can be prevented completely with this hybrid approach.