大腸癌に対するtrans-anal specimen extraction（TASE）による腹腔鏡下手術—ENDO-PSI（II）を用いた体腔内吻合

Laparoscopic colectomy with trans-anal specimen extraction（TASE）, using endoscopic purse-suture instrument ; ENDO-PSI（II）

◆要旨：当院では大腸癌に対し，標本の摘出を経肛門的に行い，吻合を腹腔鏡下で行うことで，術創がポート挿入口のみになる術式を行っているので報告する．病変の郭清，授動操作の後，自動縫合器で腸管を切離する．肛門側腸管を切開開放し，内視鏡を利用して経肛門的に標本を摘出，同時にアンビルヘッドを腹腔内に挿入する．肛門側腸管を閉鎖し，口側腸管に ENDO-PSI （II）を用いてまつり縫合をかけ，アンビルヘッドを留置する．肛門より自動吻合器を挿入しdouble-stapling technique （DST）で吻合を行う．2012年4月から2015年3月まで20例に施行し，全例完遂した．本法は，大腸癌に対する腹腔鏡下手術のさらなる低侵襲化手技の1つの選択肢となりうると考える．

This report describes the trans-anal extraction of colorectal cancer tissue. The anastomosis is performed laparoscopically using an ENDO-PSI（II） instrument, and the surgical wound is limited to the port slot. The sample is resected using an automatic suture device after the dissection and mobilization procedure. The anal side of the stumps adjacent to the anus is resected and opened, the sample is extracted trans-anally using an endoscope. An anvil head is simultaneously inserted into the abdominal cavity. After the opened intestinal incision is closed, purse string suture is placed in the oral side of the stumps, using an ENDO-PSI（II）. The staple line is resected, and the anvil head is inserted into the rostral portion of the intestine. The automatic anastomosis device is inserted through the anus, and the anastomosis is performed using the double-stapling technique（DST）. This procedure has been performed in 20cases between April 2012 and March 2015, and all cases had been accomplished. We believe that this procedure is a viable option for minimally invasive laparoscopic surgery.