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Abstract
Natural Orifice Transluminal Endoscopic Surgery (NOTES) is an important evolution in minimally invasive surgery (MIS) nowaday. Objective: to present the techniques and the firstly experience of the puro transanal laparoscopies (NOTES) in treatment of rectal cancer. Subjects and methods: Prospective study on 17 rectal cancers, adenocarcinoma, Ts T,N,M, at Hue Central Hospital, from December 2013 to December 2015. The patients were plaood in the lithotomy and Trendelenburg position, and the lone-star retractor was placed in anus (rootum cancer). Inflating of surgical cavity with CO, and setting at 12 mmhy. Continuing dissection until go inside of the abdominal cavity (transanal technique), after that, the rectum was pushed into the abdominal cavity. The IMA, IMV were divided (TME included) in both techniques. After finishing dissection, specimens were pulled out through the anus or vagina to prepare anastomosis. The coloanal or colorectal anastomosis was performed by hand-sewrn (6 cases) or by CCA staplers (11 cases). Results: 2 patients needed one more 5 mm umbilical port in RLQ, 1 patient needed two 5mm trocars (post radiation hemorrhagy, urethral perforation,...). The operation time was 258 ± 40 (190-300). All patients required minimal analgesia. Bowel movement returned on the first day in 12 patients (average: 2 days, maximum: 3 days). The hospital stay was 8 1 2.6 (4-14 days). Kirwan clasification (sphinter function) is very good (stage 1: 16). Conclusions: Pure transanal laparoscopy in treatment of rectal cancer are feasible and safe. Good quality of TME and intersphincter saving. However, a multicentric study in a large numbers of patient and a long follow- up is necessary
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