NOTES Rectosigmoid Resection Using Transanal Endoscopic Microsurgery (TEM) with Transgastric Endoscopic Assistance: A Pilot Study in Swine

  • Patricia Sylla
  • Field F. Willingham
  • Dae K. Sohn
  • Denise Gee
  • William R. Brugge
  • David W. Rattner
ssat plenary presentation



Transanal endoscopic microsurgery (TEM) provides direct endoscopic access to the rectum and peritoneal cavity. The feasibility of natural orifice translumenal endoscopic surgery (NOTES) rectosigmoid resection using TEM was evaluated in swine. Transgastric endoscopic assistance to extend transanal colon mobilization was also investigated. Full-thickness circumferential rectal dissection was performed and extended proximally. After maximal sigmoid mobilization, the specimen was exteriorized and transected, and the proximal colon was stapled to the distal rectum. In a subset of animals, transgastric endoscopic access was used to mobilize the colon further.


Rectosigmoid resection using TEM was performed in two non-survival and seven swine cadavers (n = 9). The mean procedure time was 3 h (2.5–4 h), and mean length of resected colon was 16.7 cm (10–25 cm). Transgastric endoscopic assistance was used in three cadavers and two non-survival swine (n = 5) with a mean operative time of 3.5 h (3.5–3.75 h). The mean length of colon mobilized with transgastric and transanal endoscopic access was 24.4 cm (20–27 cm) vs. 16.7 cm which mobilized the transanal approach alone (p = 0.016). A posterior anastomotic defect was noted in two animals.


Transanal rectosigmoid resection with TEM is feasible in swine. Combined transgastric and TEM access is a promising new technique for NOTES colorectal resection.


NOTES TEM Transanal Transgastric Rectosigmoid Endoscopic 


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Copyright information

© The Society for Surgery of the Alimentary Tract 2008

Authors and Affiliations

  • Patricia Sylla
    • 1
    • 4
  • Field F. Willingham
    • 2
  • Dae K. Sohn
    • 3
  • Denise Gee
    • 1
  • William R. Brugge
    • 2
  • David W. Rattner
    • 1
  1. 1.Department of Surgery, Massachusetts General HospitalHarvard Medical SchoolBostonUSA
  2. 2.Department of Medicine, Gastrointestinal Unit, Massachusetts General HospitalHarvard Medical SchoolBostonUSA
  3. 3.Center for Colorectal Cancer, Research Institute and HospitalNational Cancer CenterGoyangKorea
  4. 4.BostonUSA

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