Cargando…

Abdomino-endoscopic perineal excision of the rectum for benign and malignant pathology: Technique considerations for true transperineal verus transanal total mesorectal excision endoscopic proctectomy

PURPOSE: Transanal minimally invasive surgery using single port instrumentation is now well described for the performance of total mesorectal excision with restorative colorectal/anal anastomosis most-often in conjunction with transabdominal multiport assistance. While non-restorative abdomino-endos...

Descripción completa

Detalles Bibliográficos
Autores principales: Al Furajii, Hazar, Kennedy, Niall, Cahill, Ronan A.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Medknow Publications & Media Pvt Ltd 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5206846/
https://www.ncbi.nlm.nih.gov/pubmed/27934790
http://dx.doi.org/10.4103/0972-9941.194976
_version_ 1782490306625667072
author Al Furajii, Hazar
Kennedy, Niall
Cahill, Ronan A.
author_facet Al Furajii, Hazar
Kennedy, Niall
Cahill, Ronan A.
author_sort Al Furajii, Hazar
collection PubMed
description PURPOSE: Transanal minimally invasive surgery using single port instrumentation is now well described for the performance of total mesorectal excision with restorative colorectal/anal anastomosis most-often in conjunction with transabdominal multiport assistance. While non-restorative abdomino-endoscopic perineal excision of the anorectum is conceptually similar, it has been less detailed in the literature. METHODS: Consecutive patients undergoing non-restorative ano-proctectomy including a transperineal endoscopic component were analysed. All cases commenced laparoscopically with initial medial to lateral mobilisation of any left colon and upper rectum. The lower anorectal dissection started via an intersphincteric or extrasphincteric incision for benign and malignant pathology, respectively, and following suture closure and circumferential mobilisation of the anorectum, a single port (GelPOINT Path, Applied Medical) was positioned allowing the procedure progress endoscopically in all quadrants up to the cephalad dissection level. Standard laparoscopic instrumentation was used. Specimens were removed perineally. RESULTS: Of the 13 patients (median age 55 years, median BMI 28.75 kg/m(2), median follow-up 17 months, 6 males), ten needed completion proctectomy for ulcerative colitis following prior total colectomy (three with concomitant parastomal hernia repair) while three required abdominoperineal resection for locally advanced rectal cancer following neoadjuvant chemoradiotherapy. Median operative time was 190 min, median post-operative discharge day was 7. Eleven specimens were of high quality. Four patients developed perineal wound complications (one chronic sinus, two abscesses needing drainage) within median 17-month follow-up. CONCLUSION: Convergence of transabdominal and transanal technology and technique allows accuracy in combination operative performance. Nuanced appreciation of transperineal operative access should allow specified standardisation and innovation.
format Online
Article
Text
id pubmed-5206846
institution National Center for Biotechnology Information
language English
publishDate 2017
publisher Medknow Publications & Media Pvt Ltd
record_format MEDLINE/PubMed
spelling pubmed-52068462017-01-25 Abdomino-endoscopic perineal excision of the rectum for benign and malignant pathology: Technique considerations for true transperineal verus transanal total mesorectal excision endoscopic proctectomy Al Furajii, Hazar Kennedy, Niall Cahill, Ronan A. J Minim Access Surg Original Article PURPOSE: Transanal minimally invasive surgery using single port instrumentation is now well described for the performance of total mesorectal excision with restorative colorectal/anal anastomosis most-often in conjunction with transabdominal multiport assistance. While non-restorative abdomino-endoscopic perineal excision of the anorectum is conceptually similar, it has been less detailed in the literature. METHODS: Consecutive patients undergoing non-restorative ano-proctectomy including a transperineal endoscopic component were analysed. All cases commenced laparoscopically with initial medial to lateral mobilisation of any left colon and upper rectum. The lower anorectal dissection started via an intersphincteric or extrasphincteric incision for benign and malignant pathology, respectively, and following suture closure and circumferential mobilisation of the anorectum, a single port (GelPOINT Path, Applied Medical) was positioned allowing the procedure progress endoscopically in all quadrants up to the cephalad dissection level. Standard laparoscopic instrumentation was used. Specimens were removed perineally. RESULTS: Of the 13 patients (median age 55 years, median BMI 28.75 kg/m(2), median follow-up 17 months, 6 males), ten needed completion proctectomy for ulcerative colitis following prior total colectomy (three with concomitant parastomal hernia repair) while three required abdominoperineal resection for locally advanced rectal cancer following neoadjuvant chemoradiotherapy. Median operative time was 190 min, median post-operative discharge day was 7. Eleven specimens were of high quality. Four patients developed perineal wound complications (one chronic sinus, two abscesses needing drainage) within median 17-month follow-up. CONCLUSION: Convergence of transabdominal and transanal technology and technique allows accuracy in combination operative performance. Nuanced appreciation of transperineal operative access should allow specified standardisation and innovation. Medknow Publications & Media Pvt Ltd 2017 /pmc/articles/PMC5206846/ /pubmed/27934790 http://dx.doi.org/10.4103/0972-9941.194976 Text en Copyright: © 2017 Journal of Minimal Access Surgery http://creativecommons.org/licenses/by-nc-sa/3.0 This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
spellingShingle Original Article
Al Furajii, Hazar
Kennedy, Niall
Cahill, Ronan A.
Abdomino-endoscopic perineal excision of the rectum for benign and malignant pathology: Technique considerations for true transperineal verus transanal total mesorectal excision endoscopic proctectomy
title Abdomino-endoscopic perineal excision of the rectum for benign and malignant pathology: Technique considerations for true transperineal verus transanal total mesorectal excision endoscopic proctectomy
title_full Abdomino-endoscopic perineal excision of the rectum for benign and malignant pathology: Technique considerations for true transperineal verus transanal total mesorectal excision endoscopic proctectomy
title_fullStr Abdomino-endoscopic perineal excision of the rectum for benign and malignant pathology: Technique considerations for true transperineal verus transanal total mesorectal excision endoscopic proctectomy
title_full_unstemmed Abdomino-endoscopic perineal excision of the rectum for benign and malignant pathology: Technique considerations for true transperineal verus transanal total mesorectal excision endoscopic proctectomy
title_short Abdomino-endoscopic perineal excision of the rectum for benign and malignant pathology: Technique considerations for true transperineal verus transanal total mesorectal excision endoscopic proctectomy
title_sort abdomino-endoscopic perineal excision of the rectum for benign and malignant pathology: technique considerations for true transperineal verus transanal total mesorectal excision endoscopic proctectomy
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5206846/
https://www.ncbi.nlm.nih.gov/pubmed/27934790
http://dx.doi.org/10.4103/0972-9941.194976
work_keys_str_mv AT alfurajiihazar abdominoendoscopicperinealexcisionoftherectumforbenignandmalignantpathologytechniqueconsiderationsfortruetransperinealverustransanaltotalmesorectalexcisionendoscopicproctectomy
AT kennedyniall abdominoendoscopicperinealexcisionoftherectumforbenignandmalignantpathologytechniqueconsiderationsfortruetransperinealverustransanaltotalmesorectalexcisionendoscopicproctectomy
AT cahillronana abdominoendoscopicperinealexcisionoftherectumforbenignandmalignantpathologytechniqueconsiderationsfortruetransperinealverustransanaltotalmesorectalexcisionendoscopicproctectomy