経腟的標本摘出法を用いた完全腹腔鏡下右側結腸癌手術

Totally laparoscopic colectomy with transvaginal specimen extraction for right-sided colon cancer

◆要旨：腹腔鏡下手術の低侵襲化の潮流として，natural orifice specimen extraction （以下，NOSE）が挙げられる．筆者らは，2011年1月から現在までに，右側大腸癌切除標本の経腟的摘出を4例に施行した．適応は漿膜浸潤のない比較的小さな腫瘍である．郭清・授動操作の後，腫瘍から適切な距離を計測して腸管を切離し，完全体内吻合を機能的端々吻合で行った．経腟的に後腟円蓋を約3cm横切開してAlexis^® Wound Retractor （Applied Medical社）で腟を保護し，その中を通して標本を摘出した．腟切開口は経腟的に縫合閉鎖した．現在までに合併症や再発はない．全例1病日に歩行を開始した．2病日以降に鎮痛処置を必要としたのは1例のみであった．今後，1つのオプションとして期待できる術式であると考える．

　Natural orifice specimen extraction （NOSE） has been developed as one of the current minimal invasive surgeries. We have performed totally laparoscopic colectomy with transvaginal specimen extraction （TVSE） for right-sided colon cancer in 4 patients. TVSE was indicated for patients with clinical stage T3 or lower primary tumors. It was not indicated for patients with large tumor or for obese patients. Lymph node dissection and mobilization of the right colon were performed laparoscopically in the conventional manner. After measuring appropriate distance from the tumor, the mesentery and intestines were transected to achieve colectomy. An intracorporeal anastomosis was then performed with linear staplers using the functional end to end technique. A 3-cm length transverse transvaginal posterior colpotomy was performed. After the application of the Alexis^® wound retractor （Applied Medical, Rancho Santa Margarita, CA） into the vagina, a Babcock was inserted through it, and the specimen was grasped and extracted transvaginally. The vaginal incision was then closed with double layer running absorbable sutures transvaginally. None of the 4 patients developed postoperative complications or cancer recurrence. All patients were able to walk at 1st post operative day. Only one patient required oral analgesics administration after 2nd post operative day. In conclusion, we believe that totally laparoscopic colectomy with TVSE is one of the promising surgical options.