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

This video presents a new method for colorectal anastomosis in an easy and reproducible stepwise approach.

Usually, Body Mass Index (BMI) is correlated to the difficulty in performing the surgery. Obesity is associated with a more complex surgery and a longer operative time due to difficulties in finding the right plane of dissection and identifying the structures. However, treating a thin patient may also be dangerous because the planes of dissection are more adherent, which makes it harder to identify the real embryological dissection plane.
This video shows the danger of dissection when the mesocolon is very thin and adherent to Toldt’s fascia or Gerota’s fascia.

The nightmare of colon and rectum surgery is the leak of the anastomosis. It may occur also with all precaution: no anastomotic tension, the evaluation of the vascularization may be difficult because macroscopic lesion, when there is an ischemia, would appear after some hours; the use of the ICG test is a good tool to control the poor vascularization of the anastomosis earlier and to correct it, hence avoiding the drama of the leak.

Dr. Michael LI (Pamela Youde Nethersole Eastern Hospital, Hong Kong) demonstrates his approach to laparoscopic sigmoidectomy in a case of sigmoid diverticulitis with an audience made up of renowned experts in colorectal surgery. Discussions around appropriate strategies for the management of non-oncologic disease between the operating surgeon and the experts are moderated by Professor Nicolas Demartines (Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland). A brand-new dissecting instrument, the Sonicision™ cordless ultrasonic dissection device (Covidien, Valleylab) is also used during specific steps of the procedure.

This video demonstrates an uncomplicated laparoscopic sigmoid colectomy for cancer in a normal weight lady. The surgeon uses a medial approach to mesenteric mobilization and division of inferior mesenteric artery at the root. The hypogatric nerves, ureter and gonadal artery are identified. The splenic flexure is not mobilized due to the length of the bowel. The bowel is removed through a suprapubic incision and an EEA anastamosis is made.
This video is a good demonstration of key anatomical landmarks and surgical approach to sigmoid colectomy for cancer through the medial approach.

In this authoritative lecture, Dr. Salky focuses on intracorporeal anastomosis in laparoscopic colectomy.