Surgical Technique And Clinical Outcome For Laparoscopic-assisted Natural Orifice Specimen Extraction Radical Left Colorectomy Using A Cai Tube

Objective To introduce sterile and oncological concerns and methods to fixate the anvil head in the proximal colon intracorporeally during laparoscopic-assisted natural orifice specimen extraction radical left colorectomy using a Cai Tube,so as to solve the technical difficulties of digestive tract reconstruction in LA-NOSE surgery.Methods During August 2015 and January 2018,32 cases of left colorectal cancer were performed LA-NOSE using a Cai Tube by the team of surgeons from the Department of Gastrointestinal Surgery at Zhongshan Affiliated Hospital of Xiamen University.For the intracorporeal anastomosis,the anvil was brought into the abdominal cavity through the Cai Tube.The anvil was fixated in the proximal colon under laparoscopic control to a site intended division.At last,the anastomosis by a circular stapler transanally was created in the conventional end-to-end fashion.Results There was no conversion to open in the whole group,including 22 males(68.75%)and 10 females(31.25%);The average age was 62±11 years(range 39?52);The average body mass index was 22.5±2.5 kg/m2(range 16?27.1);The average operative time was 207±61 min;The average blood lose was 49.1±25.8 ml;The average length of specimen was 16.4±5.5 cm;The average tumor size was 3.8±1.1 cm;The average length of distal margin was 4.1 ±2.3 cm;The mean lymph nodes harvested were 14±5;The anastomotic leakage occurred in 2 cases,The anastomotic bleeding occurred in 2 cases.The peritoneal infection was not observed in these cases.Conclusion The technical improvement of the five methods and the sterile and oncological concerns can effectively prevent the peritoneal infection during laparoscopic-assisted natural orifice specimen extraction radical left colorectomy using a Cai Tube,and the operation is safe and feasible.