What is your experience of NOTES in Asia? Do you have or do you see any applications of NOTES in colorectal surgery?

Laparoscopic colectomy has significant patient benefits but is technically challenging. Hand-assisted laparoscopic surgery (HALS) allows for tactile feedback because the surgeon's hand assists in retraction and dissection. This may decrease the technical difficulty. In this lecture, Dr. Whelan presents the different aspects of the two procedures.

The video demonstrates the case of a woman with recurrent diverticulitis, BMI 30. She has a background of a previous hysterectomy via a Pfannenstiel incision. A three-port sigmoidectomy with transanal excision was carried out.
Methods
The set up consisted of a 12mm umbilical optical port, a 12mm port in the right iliac fossa, and a 5mm operating port in the right flank. After initial peritoneoscopy, any abnormal adhesions were divided. The sigmoid colon mesentery was divided high, near the sigmoid colon in order to preserve the mesenteric vasculature. The mesentery was divided to the level of the rectum, which was then skeletonized. The proximal colon was mobilized free up to the level of the splenic flexure. The rectum was then ligated, washed out with betadine and transected. A Vicryl Loop was attached to the proximal stump which was then removed transanally. A colotomy was created above the level of the diverticula and the anvil of a circular stapler introduced into the proximal colon. The proximal sigmoid colon mesentery was divided and the sigmoid transected with a linear stapler. The specimen was then fully removed transanally. The anvil was then delivered through the colon via the fishing technique. The rectal stump was closed with a linear stapler. A colorectal anastomosis was fashioned with a circular stapler. After verifying that the colon was not twisted, an air test was performed.
Conclusion
The video demonstrates a three-port technique for laparoscopic sigmoidectomy with natural orifice specimen extraction (NOSE).

In this lecture, Dr. Barry Salky presents the current status of the treatment of Crohn’s disease and shows his personal experience regarding the laparoscopic treatment in case of fistulous disease.

In this key lecture, Professor Martin Walz explains the medial appoach to the left (splenic) flexure of the colon.

The video entitled "Complicated sigmoiditis with sigmoido-vaginal fistula: laparoscopic management with Natural Orifice Specimen Extraction (NOSE)” authored by J Leroy, L Marx, J Marescaux is analyzed by Dr. Barry Salky, MD, FACS (Mount Sinai Medical Center, New York, USA) sharing in this way his own personal experience and highlighting the different surgical approaches available with tips and tricks.

This recording of a live case reveals all the key technical steps in laparoscopic revision of an anastomotic stenosis following a prior sigmoidectomy.

The video "Three-trocar laparoscopic sigmoidectomy and transanal extraction of the specimen for diverticular sigmoiditis" authored by J. Leroy and J. Marescaux is analysed by Dr. Barry Salky, MD, sharing in this way his own personal experience and highlighting the different surgical approaches available with tips and tricks.