Hospital Clínic of Barcelona developed a technique pioneered in the world for total removal of the colon through the anus

It is the simplest form of surgery. It is called MANOS (Microlaparoscopy Assisted Natural Orifice Surgery) and represents the evolution of the technique NOTES (Natural Orifice Transluminal Endoscopy Surgery), the surgical approach that allows to operate through the body's natural openings, used to remove tumors or organs through vagina, mouth or anus. Dr. Antonio Mª de Lacy, Head of Gastrointestinal Surgery Unit at the IDIBAPS - Hospital Clínic of Barcelona, a pioneer in developing minimally invasive surgical techniques, has made for the first time ever the complete removal of the colon through the anus, using a hybrid technique that combines laparoscopy and endoscopy, and avoids the infectious complications related to the transanal route. Results will be published in the journal Surgical Endoscopy.

Àlex y el Dr. LacyOn 13 July, the team surgeons, anesthesiologists and nurses from the Catalan hospital, led by Dr. de Lacy, in collaboration with Dr. Graciela Martinez and Dr. Raquel Bravo, from the Reanimation and Anesthesiology Service and the Digestive Surgery Service respectively, operated a 36 year old man diagnosed with severe ulcerative colitis, a disease which affects around 70.000 people in Spain, with 6.000 to 8.000 new cases every year. It is the first time in the world that a total colectomy (removal of the entire colon) is made in the treatment of inflammatory disease of the large intestine, a severe disease causing abdominal pain, frequent diarrhea and the appearance of blood and mucus in the stool. Ulcerative colitis is in a group of so-called inflammatory bowel diseases, as Crohn's disease: these are chronic diseases   with recurrent manifestations. Unlike Crohn's disease, which affects the entire digestive tract (from mouth to anus), ulcerative colitis affects only the colon, especially in the most distal (rectum).

In the present case, the failure of immunosuppressive drug therapy (although its cause is unknown, many hypotheses suggest an autoimmune origin of ulcerative colitis), motivated the surgery for total removal of the affected organ. "When the surgery is justified by the immunosuppressive treatment-resistant disease, total colectomy and subsequent reconstruction of the organ are presented as the only solution", said Dr. de Lacy. This patient was the perfect candidate for less invasive surgery because of his malnutrition, anemia and frequent intake of steroid drugs.

During the operation all surgical instruments were introduced through the anus to prevent painful abdominal incisions. This new technique has been developed to achieve better results than laparoscopic surgery, and even than NOTES surgery, minimally invasive techniques that guarantee many advantages: reduced pain, shorter hospital stay and better oncologic results. MANOS technique was performed through three laparoscopic ports in the abdomen (12, 3 and 5mm each). The larger diameter was used for subsequent ileostomy (a surgical opening in the abdominal wall to take out the intestinal waste when the colon or rectum do not work properly). Thanks to the joint efforts of this team of experts, the surgery has gone a step further and now it is possible to operate successfully chronic inflammatory diseases without scarring, unlike the aforementioned laparoscopy, whose scars are reduced to 4 or 5 minimal incisions.

"The procedure was done because it was identified as the only possible solution", said Dr. de Lacy. Never before had this operation been performed through the rectum, but the IDIBAPS – Hospital Clínic’s team has proven it to be a safe and extrapolated for future cases. "The result, after four hours of intervention, has been successful and confirmed the new technique as a reliable MANOS surgical tool", he concludes.

La Dra. Bravo, la Dra. Ricart, la Dra. Martínez, Àlex y el Dr. Lacy