Robotic natural orifice specimen extraction (NOSE) total colectomy with ileorectal anastomosis: a step-by-step video-guided technical note

Excerpt

Total colectomy with ileorectal anastomosis (TC-IRA) is indicated for familial adenomatous polyposis (FAP) and colonic inertia (CI). FAP is an inherited autosomal dominant disease, and the affected individuals inevitably develop cancer at a relatively young age if this condition remains untreated. However, in consideration of retaining anorectal function for young patients with FAP, TC-IRA may be the first choice, although total proctocolectomy with ileal pouch-anal anastomosis may be eventually inevitable for such patients to prevent colorectal cancer [1]. CI, also known as slow-transit constipation, is a colorectal motility disorder, in which severe constipation cannot be effectively treated by conservative treatment and total colectomy is frequently required. Most reported series have shown that TC-IRA can significantly improve the quality of life for such patients [2, 3]. However, TC-IRA is a complex procedure, and postoperative complications are a major issue [4, 5], such as the potentially higher rate of postoperative adhesion ileus owing to extensive abdominal dissection required in this surgical procedure [6, 7]. …