MA-NOS radical sigmoidectomy: report of a transvaginal resection in the human |
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Authors: | Antonio M Lacy Salvadora Delgado Oscar A Rojas Raúl Almenara Anabel Blasi Josep Llach |
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Institution: | Department of Gastrointestinal Surgery and Centro de Investigaciones Biomédicas Esther Koplowitz, Institut de Malalties Digestives I Metaboliques, IDIBAPS, Hospital Clínic, University of Barcelona, Barcelona, Spain. alacy@clinic.ub.es |
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Abstract: | Background With available laparoscopic and endoscopic instruments/technology a standard radical sigmoid resection is feasible and safe
using transvaginal minilaparoscopic-assisted natural orifice surgery (MA-NOS).
Methods The intervention was a transvaginal MA-NOS sigmoidectomy in a 78-year-old woman with a sigmoid adenocarcinoma. Maintaining
triangulation the surgeon positioned himself at the right side of the patient and used the transvaginal trocar for dissection
and stapling of both the inferior mesenteric vessels and the upper rectum. The colonic resection was performed extracorporeally
in the conventional fashion and was followed by an intra-abdominal endoscopically assisted stapled anastomosis.
Results Advantages of minimally invasive surgery seemed to be enhanced with this hybrid laparoscopic approach. Postoperative course
was uneventful. All oncological principles governing resection and management were accomplished and the pathology examination
confirmed a T3N1 lesion. The patient was discharged on the fourth postoperative day.
Conclusion Transvaginal MA-NOS radical sigmoidectomy is a feasible and oncologically safe procedure. MA-NOS is a realistic option for
avoiding the need of assisting incisions and related morbidity in the laparoscopic resection of large intra-abdominal lesions.
Combined hybrid laparoscopic NOS in humans (MA-NOS) currently provides a safe and reliable way of defining future clinical
applications and advantages of NOS and NOTES. Additionally, it stimulates the active development and evaluation of the underpinning
technologies and instrumentation. |
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Keywords: | NOS MA-NOS NOTES Transvaginal Sigmoidectomy MIS MAS |
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