NOTES transanal rectal cancer resection using transanal endoscopic microsurgery and laparoscopic assistance
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The feasibility and safety of Natural Orifice Translumenal Endoscopic Surgery (NOTES) transanal endoscopic rectosigmoid resection using transanal endoscopic microsurgery (TEM) was previously demonstrated in human cadavers and a porcine survival model. We report the first clinical case of a NOTES transanal resection for rectal cancer using TEM and laparoscopic assistance, performed by a team of surgeons from Barcelona and Boston with extensive experience with NOTES and minimally invasive approaches to colorectal diseases.
Transanal endoscopic rectal resection with total mesorectal excision using the TEM platform was performed in a 76-year-old woman with a T2N2 rectal cancer treated with preoperative chemoradiation. Laparoscopic visualization and assistance with retraction and exposure during rectosigmoid mobilization was provided through one 5-mm port, which was later used as the stoma site, and 2-mm needle ports, one of which was used as a drain site. The specimen was transected transanally followed by handsewn coloanal anastomosis.
The procedure was completed successfully with an operative time of 4 hours and 30 minutes. Mesorectal excision was complete. The postoperative course was uneventful, and the patient was discharged on the fourth postoperative day. The final pathology demonstrated pT1N0 with 23 negative lymph nodes and negative proximal, distal, and radial margins.
NOTES transanal endoscopic rectosigmoid resection using TEM and laparoscopic assistance is feasible and safe. Careful patient selection and improvement in NOTES instrumentation are critical to optimize this approach before widespread clinical application.
KeywordsNatural Orifice Translumenal Endoscopic Surgery Transanal endoscopic microsurgery Transanal Rectal cancer
- 1.Rao GV (2006). Transgastric appendectomy results and follow-up. (SAGES transgastric surgery panel). Presented at: SAGES meeting 2006Google Scholar
- 8.Horgan S, Cullen JP, Talamini MA, Mintz Y, Ferreres A, Jacobsen GR, Sandler B, Bosia J, Savides T, Easter DW, Savu MK, Ramamoorthy SL, Whitcomb E, Agarwal S, Lukacz E, Dominguez G, Ferraina P (2009) Natural orifice surgery: initial clinical experience. Surg Endosc 23:1512–1518CrossRefPubMedGoogle Scholar
- 9.Alcaraz A, Peri L, Molina A, Goicoechea I, García E, Izquierdo L, Ribal MJ (2009) Feasibility of transvaginal NOTES-assisted laparoscopic nephrectomy. Eur Urol Sep 18 [Epub ahead of print]Google Scholar
- 21.Sylla P, Sohn DK, Cizginer S, Konuk Y, Turner BG, Gee DW, Willingham FF, Hsu M, Mino-Kenudson M, Brugge WR, Rattner DW (2010) Survival study of NOTES rectosigmoid resection using transanal endoscopic microsurgery with or without transgastric endoscopic assistance in a swine model. Surg Endosc (in press)Google Scholar
- 23.Cataldo PA (2006) Transanal endoscopic microsurgery. Surg Clin North Am 63:199–203Google Scholar
- 25.Fajardo AD, Hunt SR, Fleshman JW, Mutch MG (2010) Transanal single-port low anterior resection in a cadaver model. Sur Endosc Jan 7 (Epub)Google Scholar