Combined single-port and endoluminal technique for laparoscopic anterior resection.

OBJECTIVE: To determine the technical feasibility and clinical outcomes of laparoscopic anterior resection using combined single-port and endoluminal technique. METHODS: A single port was placed at the umbilicus. Sigmoid colon was retracted using transabdominal sutures. After adequate mobilization, the colon was stapled distal to the lesion using noncutting endostapler, and the rectum was opened distal to the staple line. The transanal endoscopic operation device was placed transanally and the anvil of a circular stapler was then delivered through the device into the peritoneal cavity. The anvil was placed intraluminally through a colotomy made proximal to the lesion; after this, the colon was transected above the colotomy site. The specimen was next delivered transanally through the transanal endoscopic operation device. Finally, the rectum was closed with endostapler and intracorporeal side-to-end colorectal anastomosis was constructed using the circular stapler. RESULTS: This technique was attempted in an 80-year-old woman with a 3 cm sessile polyp in the distal sigmoid. Laparoscopic anterior resection was arranged as the polyp was not amenable to endoscopic removal. The operative time was 150 minutes. There was no intraoperative complication. The patient was discharged on postoperative day 6, with a maximum pain score of 3. CONCLUSIONS: Laparoscopic anterior resection using this combined single-port and endoluminal technique is feasible for small lesions in the sigmoid colon or upper rectum. The technique avoids multiple trocar incisions and a minilaparotomy for specimen retrieval.

Combined endolaparoscopic intragastric excision for gastric neoplasms.

BACKGROUND: The aim of this study was to describe our technique of combined endolaparoscopic approach to the management of intraluminal gastric neoplasms and to review the clinical outcome. METHODS: Between February 2006 and January 2008, a total of 12 patients with gastric neoplasm < or =4 cm with a mainly intraluminal component received the combined endolaparoscopic intragastric excision and were prospectively analyzed. All lesions were localized endoscopically and then treated by using a combined endoscopic submucosal dissection and laparoscopic intragastric technique. RESULTS: Eight of 12 lesions were gastrointestinal stromal tumours. The remaining lesions were adenomatous polyp with focal intramucosal adenocarcinoma, leiomyoma, and pancreatic heterotopia. All except 1 case was successfully treated with this technique (91.6%). There were no mortalities, and there was only 1 case of reactionary hemorrhage from the port site requiring a reoperation. The median operating time was 120 minutes, with a median blood loss of 35 mL. Length of hospital stay ranged from 3 to 12 days. There were no recurrences during the follow-up period. CONCLUSIONS: This combined endolaparoscopic intragastric excision technique is a truly minimally invasive alternative for selected gastric neoplasm. It is safe and feasible with a satisfactory short-term outcome.

Towards painless colonoscopy: a randomized controlled trial on carbon dioxide-insufflating colonoscopy.

BACKGROUND: Carbon dioxide (CO2) insufflation during colonoscopy was reported to reduce pain, but data are limited. The objective of this randomized controlled trial was to assess the effect of CO2 insufflation on pain during and after colonoscopy. METHODS: Patients were randomized into CO2 insufflation (CO2i) or air insufflation (AIRi) groups. Pain during and after the examination were recorded using a visual analogue scale. Other outcomes included the caecal intubation rate, time to reach the caecum and complication. With questionnaire, patients' satisfaction and acceptance of the procedure were assessed. RESULTS: Over a 4-month period, 96 patients were recruited. The caecal intubation rate was 96 and 98% in the CO2i group and the AIRi group, respectively. No complication occurred in the CO2i group whereas one patient from the AIRi group developed late haemorrhage after polypectomy. Patients in the CO2i group had a lower pain score during (P < 0.01) and 30 min after (P = 0.02) the examination. Significantly more patients in the CO2i group reported the examination as painless (visual analogue scale 0) during the procedure (45 vs 14%, P < 0.01) and 30 min after (70 vs 51%, P = 0.04). In both groups, high satisfaction scores were recorded. Most patients (93% for the CO2i group and 98% for the AIRi group) would accept another colonoscopy if indicated. CONCLUSION: Insufflation with CO2 during colonoscopy results in less pain during and after the examination. Because of better tolerance, colonoscopy with CO2 insufflation might gain wide acceptance in the community to be used as a screening tool.