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Purpose: To evaluate the early results of the feasibility and safety on technology and oncologic transanal total mesorectal excision (down to up). Materils and method: Prospective study from 2012 to 2018. Patients: 23 rectum adenocarcinoma staging T ≤ 3, N ≤ 1, M0 were operated using one of two modalities Hybrid NOTES (A) and NOTES (B). Results: Twenty three patients with Rectal cancer were sucessfully in total mesorectal excision performed by Hybrid NOTES and NOTES procedures. Three cases in group NOTES had per-operative complications such as bleeding or urethra injury required one or two trocarts for assistance, no conversion to open surgery and no mortality. The operation time: group A (Hybrid NOTES): 190 ± 47 (120-280) mins; group B (NOTES): 258 ± 40 (190-300) mins. The hospital stay: 9 ± 2.7 (4-19) day. Conclusions: transanal total mesorectal excision (down to up) endoscopic surgery (NOTES) and Hybrid NOTES is feasible and safe.However, a study in a large number of patient and long follow-up is necessary. Key words: Mesorectum, Natural orifice transluminal endoscopic surgery (NOTES), Hybrid NOTES, rectal cancer

Objectives: The evaluation of feasibility, safety, and outcomes of single port laparoscopic colectomy (SPLC) for colonic cancer. Prospective study of 114 patients with colonic cancer (84 right side, 17 left side, and 13 sigmoid colon) who underwent SPLC between October 2010 and October 2016 in Hue Central Hospital. Results: Mean age of patients was 56.1±15.2 (25-87 years), male/female ratio was 70/44. Mean BMI was 23.5±2.2 kg/m2. Procedures included 84 right hemi-colectomies (73.7%), 17 left hemi-colectomies (14.9%), and 13 sigmoidectomies (11.4%). Six cases required additional ports, and 19 were converted to open surgery. Mean tumor size was 3.7±2.7 cm. Stage I: 6.1%; stage IIa: 43.9%; stage IIIa: 36.8%; and stage IIIc: 13.2%. Mean operation time was 160.5±75.5 min. There had been no deaths/intraoperative complications. Mean incisional length (including extraction) was 5.5±2.2 cm. Mean lymph nodes was 16.2±4.5. Mean hospital stay was 7.5±6.1 days. The surgical site infection rate was 3.5%, and 1 patient required reoperation (anastomotic leakage: 0.9%). After 32.2±7.5 (3-65 months) follow-up, there were no late surgical complication, incisional hernia, or incision metastasis. There were five local recurrences, and three patients developed liver metastasis in the open conversion group. The overall survival time after 2 years was 87.5%, and after 5 years, it was 59.4% (Kaplan-Meier). Conclusion: SPLC is feasible and safe procedure for the treatment of colon cancer. The cosmetic value is better (short incision confounded by umbilicus). Other outcomes were equivalent to conventional laparoscopy.

Objective: Natural Orifice Transluminal Endoscopic Surgery (NOTES) is an important evolution in minimally invasive surgery (MIS) nowaday. This paper presents the techniques and early results of the pure transanal and transvaginal laparoscopies (NOTES) used for the treatment of colorectal cancer. Material and method: Prospective studies were conducted at Hue Central Hospital, Vietnam. Patients: From December 2013 to September 2015, 22 cololorectal cancer patients (18 rectums, 3 sigmoid tumors and 1 descending colon), adenocarcinoma, T≤ T3N1M0. Methods: The patients were placed in lithotomy and Trendelenburg positions, and the lone-star retractor was placed in the anus (rectum cancer) or vagina (sigmoid cancer). The surgical cavity was then inflated with CO2 and set at 12 mm/Hg. Dissection was continued until inside of the abdominal cavity (transanal technique). After that, the rectum was pushed into the abdominal cavity. The IMA and IMV were divided (TME included) in both techniques. After finishing dissection, the specimens were pulled out through the anus or vagina to prepare anastomosis. Coloanal and colorectal anastomosis were either hand-sewn (6 cases) or sealed with EEA staplers (16 cases). Results: 2 patients needed one more 5 mm umbilical port in RLQ, 2 patients needed two 5 mm trocars (post radiation hemorrhage, and urethral perforation). One patient converted to open and 1 patient converted to the HYBRID-NOTES procedure. The operation time was 258±40 (190-300) minutes. All patients required minimal analgesia. Bowel movement returned on the first day to 16 patients (average: two days, maximum: three days). The hospital stay was 7±2.8 (4-14) days. Kirwan classification (sphincter function) was very good (stage I: 18). Conclusions: Pure transanal and transvaginal laparoscopies for the treatment of colorectal cancer are feasible and safe. We believe that this is the first pure transvaginal laparoscopy (NOTES) for human in the world. A multicentric study in a large numbers of patients and a long follow-up is necessary.

Purpose: Analysis about disease, technical characteristics of 17 right colon cancer patients underwent conversion to laparotomy from single port laparoscopic surgery and propose related factors for indications. Methold: Consist of 17 colon cancer patients, who were conversion to laparotomy from single port laparoscopic colectomy at Hue Central Hospital from october 2010 to august 2014. Results: Mean age 61.3±14.2 years, rate male/female 11/6. Tumor invasion: T2 11.8%, T3 58.8%, T4 29.4%. Mean tumor size on CT 6.5±2.2cm. The causes of conversion: very big tumors 29.4%, invasive-adhesive tumors 47.1%, extended surgery 23.5%. Open procedures: right hemicolectomy 70.6%, right hemicolectomy plus cholecystectomy 5.9%, right hemicolectomy plus wedge-shape duodenectomy 11.8%, right hemicolectomy plus intestinal segmentectomy 5.9% and right hemicolectomy plus low-anterior rectal resection, hysterectomy 5.9%. Conclusion: Conversion to laparotomy from single port laparoscopic colectomy is necessary for very big tumors, excessive tumor adhesions and exceed the technical limitations of laparoscopic dissection. Key words: Single incision laparoscopic colectomy (SILC), single port laparoscopic colectomy (SILC), conversion to laparotomy.

Purpose: Evaluating the initial results in applying single port laparoscopic cholecystectomy at Hue Central Hospital. Patients and methods: 29 gallbladder polyps, gallstones with symptoms of acute or chronic cholecystitis and surgeried by single port laparoscopic cholecystectomy at Hue Central Hospital from March 2011 to December 2011. Results: Male/female was 0.45/1. Age: 49.24 ± 16.43 (21-81), 40 to 60 years 54.6%. Cholecystitis: 75.9%, 17.3% gallbladder polyp, gallbladder adenomyomatosis 3.4%. Added 1 trocart because difficult dissection surgery 10.2%, bleeding 6.8% difficult to handle, added 2 trocart 3.4%. Bleeding intraoperative 10.3%. Operating time: 76.2 ± 33.5 minutes, hospital stay: 4 - 6 days 51.7%. Wound pain after 2 weeks of hospital discharge 6.9%, with no wound seromas and no wound infection. Conclusions: Single port laparoscopic cholecystestomy is safe, has fewer complications, can be done with experienced surgeons laparoscopic surgery. Keywords: Single port laparoscopic cholecystectomy, gallbladder ston Key words: Single port laparoscopic cholecystectomy, gallbladder stone