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CC BY 4.0 · European J Pediatr Surg Rep. 2022; 10(01): e115-e117
DOI: 10.1055/s-0042-1751051
Case Report

Transanal Mesenteric Resection in Hirschsprung's Disease Using ICG under Concept of NOTES Technique

Mitsuru Muto
1   Department of Pediatric Surgery, Kagoshima University, Kagoshima, Japan
,
Shun Onishi 
1   Department of Pediatric Surgery, Kagoshima University, Kagoshima, Japan
,
Masakazu Murakami
1   Department of Pediatric Surgery, Kagoshima University, Kagoshima, Japan
,
Keisuke Yano
1   Department of Pediatric Surgery, Kagoshima University, Kagoshima, Japan
,
Toshio Harumatsu
1   Department of Pediatric Surgery, Kagoshima University, Kagoshima, Japan
,
Satoshi Ieiri 
1   Department of Pediatric Surgery, Kagoshima University, Kagoshima, Japan
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Abstract

Laparoscopic surgery has been applied for Hirschsprung's disease (HD). We herein report our approach to mesenteric processing for laparoscopic-assisted transanal endorectal pull-through (L-TERPT). Following mucosectomy and entering the abdominal cavity, a vessel sealing system is transanally inserted into the abdominal cavity for mesenteric processing based on concept of Natural Orifice Translumenal Endoscopic Surgery. Since the transanal axis is parallel to the dissected mesentery, it makes easier to operate in comparison to when the procedure is performed through the abdominal working port and can reduce the additional abdominal trocar wound. We also use indocyanine green (ICG) fluorescence navigation. Fluorescing the vessels with ICG allows intraoperative visualization of the blood flow in the retrieved intestine. With these innovative combined techniques, L-TERPT for HD can be safely performed, even in infants with small intraabdominal cavities.

Keywords

Hirschsprung's disease - laparoscopic-assisted transanal endorectal pull-through - NOTES - mesenteric processing - indocyanine green


Publication History

Received: 15 February 2022

Accepted: 07 May 2022

Article published online:
16 August 2022

© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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