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Natural Orifice Transluminal Endoscopic Surgery (NOTES) for colon resections—analysis of the first 139 patients of the German NOTES Registry (GNR)

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Background

The German NOTES registry (GNR) is the largest published database for natural orifice transluminal endoscopic surgery (NOTES) worldwide. Although transvaginal cholecystectomy is the most frequent procedure in the GNR, the number of colorectal resections is increasing. The objective of this study was to analyze the first 139 colonic procedures of the GNR.

Methods

All colonic procedures from the GNR were analyzed regarding patient- and therapy-related parameters. A multivariate analysis was conducted for transvaginal sigmoid resections regarding procedural time, hospital stay, conversion rate, and rate of complications.

Results

From October 2008 to January 2013, 139 colon NOTES procedures (12 male, 127 female) were registered. Main diagnoses were sigmoid diverticulitis (85.6 %), colon carcinoma (9.4 %), and ulcerative colitis (3.6 %). Sigmoid resections (87.1 %), proctocolectomies (3.6 %), right-sided resections (2.9 %), left-sided resections (3.6 %), segmental resections (2.2 %), and 1 ileocecal resection (0.7 %) were performed. All procedures were conducted in transvaginal (87.8 %) or transrectal (12.2 %) hybrid technique, with a median of 3 percutaneous trocars. Conversions to laparoscopic technique were necessary in 3.6 % (none to conventional technique). Intraoperative complications were recorded in 2.9 % and postoperative complications in 12.2 %. The institutional case number in transvaginal sigmoid resections correlated negatively with procedural time (p = 0.041) and the number of percutaneous trocars (p = 0.002).

Conclusion

The analysis of the first 139 colon NOTES operations of the GNR shows the feasibility of colon operations in hybrid technique, especially for transvaginal sigmoid resection as the most frequent procedure.

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Acknowledgments

The authors thank the DGAV (German Society for General and Visceral Surgery) for providing the technical resources for the German NOTES registry. The authors also thank Jurgen Knuth for help with the preparation of the manuscript.

The following German sites and investigators were also involved in the German NOTES Registry: T. Böttger, Department of General, Visceral and Vascular Surgery, Euromedclinic Fürth, Fürth, Germany; U. Pohlen, Department of General, Visceral and Vascular Surgery, Klinikum Offenburg, Offenburg, Germany; B. Schneider, Department of General and Visceral Surgery, St. Marien-Hospital, Bonn, Germany.

Disclosures

Drs. Dirk Rolf Bulian, Wolfram Lamadé, Jens Burghardt, Norbert Runkel, Michael Butters, Markus Utech, Klaus-Peter Thon, Rolf Lefering, Markus Maria Heiss, Heinz J. Buhr, and Kai S. Lehmann have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Department of Abdominal, Vascular and Transplant Surgery, Cologne-Merheim Medical Center, Witten/Herdecke University, Ostmerheimer Strasse 200, 51109, Cologne, Germany

    Dirk R. Bulian & Markus M. Heiss

  2. Department of Surgery, Schwarzwald-Baar-Klinikum, Villingen-Schwenningen, Germany

    Norbert Runkel

  3. Department of Surgery, Evangelisch-Freikirchliches Krankenhaus Rüdersdorf, Rüdersdorf, Germany

    Jens Burghardt

  4. Department of General, Visceral and Minimal Invasive Surgery, HELIOS Spital Überlingen, Überlingen, Germany

    Wolfram Lamade

  5. Department of General and Visceral Surgery, Krankenhaus Bietigheim, Bietigheim-Bissingen, Germany

    Michael Butters

  6. Department of General and Visceral Surgery, Klinikum Vest, Knappschaftskrankenhaus, Recklinghausen, Germany

    Markus Utech

  7. Department of General and Visceral Surgery, Robert-Bosch Hospital, Stuttgart, Germany

    Klaus-Peter Thon

  8. Institute for Research in Operative Medicine, Witten/Herdecke University, Cologne, Germany

    Rolf Lefering

  9. German Society for General and Visceral Surgery, Berlin, Germany

    Heinz J. Buhr

  10. Department of General, Visceral and Vascular Surgery, Charité University Medical Center Berlin, Campus Benjamin Franklin, Berlin, Germany

    Kai S. Lehmann

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  1. Dirk R. Bulian
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Corresponding author

Correspondence to Dirk R. Bulian.

Additional information

Presented in part to the 130th National Congress of the German Association of Surgery, Munich, Germany, May 2013.

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Bulian, D.R., Runkel, N., Burghardt, J. et al. Natural Orifice Transluminal Endoscopic Surgery (NOTES) for colon resections—analysis of the first 139 patients of the German NOTES Registry (GNR). Int J Colorectal Dis 29, 853–861 (2014). https://doi.org/10.1007/s00384-014-1883-1

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