Access: Transcolonic

Abstract

The transcolonic approach presents several advantages over the transgastric, transvaginal, and transvesicular accesses. The en face visualization of upper abdominal organs such as the stomach, liver, gallbladder, spleen, small bowel, and peritoneal surfaces has been quickly and easily achieved using this route. The direct approach avoids the loss of visual orientation, distal force transmission, and accurate haptic feedback that occurs when using a transgastric approach. Furthermore, larger specimens can be removed than via the transgastric or transvesical routes. If the colotomy is made near the anus, rigid surgical instruments can be used for rescue procedures at the incision site, avoiding laparotomy. Unlike transvaginal access, the transcolonic approach can be used in men and women. The studies summarized herein have demonstrated some disadvantages of transcolonic access. Sterility is an important concern; many studies demonstrated subsequent peritonitis or the development of adhesions. Additionally, several of the above studies noted injury to adjacent viscerae. Finally, secure colotomy closure represents a challenge; a safe, consistently effective closure method will have to be demonstrated before transcolonic NOTES can be applied widely in humans.