New trends in colorectal surgery: Single port and natural orifice techniques

• Published in: World journal of gastroenterology : WJG Vol. 20; no. 48; pp. 18104 - 18120
• Main Authors: Daher, Ronald, Chouillard, Elie, Panis, Yves
• Format: Journal Article
• Language: English
• Published: United States Baishideng Publishing Group Inc 28.12.2014
• Subjects: Cancer; Colon; Colonic Diseases - surgery; Colonoscopy - adverse effects; Colonoscopy - history; Colonoscopy - mortality; Colonoscopy - trends; Colorectal Surgery - history; Colorectal Surgery - trends; History, 20th Century; History, 21st Century; Humans; Laparoscopy; Laparoscopy - adverse effects; Laparoscopy - history; Laparoscopy - mortality; Laparoscopy - trends; Natural Orifice Endoscopic Surgery - adverse effects; Natural Orifice Endoscopic Surgery - history; Natural Orifice Endoscopic Surgery - mortality; Natural Orifice Endoscopic Surgery - trends; Postoperative Complications - etiology; Rectal Diseases - surgery; Rectum; Review; Risk Factors; Single-por; Surgery; Treatment Outcome; Natural orifice transluminal endoscopic surgery; Surgery; Rectum; Single-port; Laparoscopy; Colon; Cancer
• ISSN: 1007-9327; 2219-2840
• DOI: 10.3748/wjg.v20.i48.18104

Single-incision laparoscopic surgery(SILS)and natural orifice transluminal endoscopic surgery(NOTES)have rapidly gained pace worldwide,potentially replacing conventional laparoscopic surgery(CLS)as the preferred colorectal surgery technique.Currently available data mainly consist of retrospective series analyzed in four meta-analyses.Despite conflicting results and lack of an objective comparison,SILS appears to offer cosmetic advantages over CLS.However,due to conflicting results and marked heterogeneity,present data fail to show significant differences in terms of operative time,postoperative morbidity profiles,portsite complications rates,oncological appropriateness,duration of hospitalization or cost when comparing SILS with conventional laparoscopy for colorectal procedures.The application of"pure"NOTES in humans remains limited to case reports because of unresolved issues concerning the ideal access site,distantorgan reach,spatial orientation and viscera closure.Alternatively,minilaparoscopy-assisted natural orifice surgery techniques are being developed.The transanal"down-to-up"total mesorectum excision has been derived for transanal endoscopic microsurgery(TEM)and represents the most encouraging NOTES-derived technique.Preliminary experiences demonstrate good oncological and functional short-term outcomes.Largescale randomized controlled trials are now mandatory to confirm the long-term SILS results and validate transanal TEM for the application of NOTES in humans.