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Transanal total mesorectal excision: a pure NOTES approach for selected patients

  • Technical Note
  • Published:
Techniques in Coloproctology Aims and scope Submit manuscript

Abstract

Background

The concept of natural orifice transluminal endoscopic surgery (NOTES) has stimulated the development of various “incisionless” procedures. One of the most popular is the transanal approach for rectal lesions. The aims of this study were to report how we standardized NOTES technique for transanal mesorectal excision without abdominal assistance, discuss the difficulties and surgical outcomes of this technique and report its feasibility in a small group of selected patients.

Methods

Three consecutive female patients underwent transanal NOTES rectal resection without transabdominal laparoscopic assistance for rectal lesions. Functional results were assessed with the Fecal Incontinence Quality of Life scale and the Wexner score.

Results

The technical steps are described in details and complemented with a video. All procedures were completed without transabdominal laparoscopic help. The mesorectal plane was entirely dissected without any disruption, and distal and circumferential margins were tumor-free. No major complications were observed. Functional results show a significant impairment after surgery with improvement at 6 months to levels near those of the preoperative period.

Conclusions

The performance and publication of NOTES procedures are subject to much discussion. Despite the small number of patients, this procedure appears feasible and can be accomplished maintaining fecal continence and respecting oncologic principles.

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Author information

Authors and Affiliations

  1. Department of General Surgery, de Braga Hospital, Braga, Portugal

    P. Leão, A. Goulart, C. Veiga, H. Cristino & M. Rodrigues

  2. Surgical Sciences Research Domain, Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, de Gualtar Campus, 4709-057, Braga, Portugal

    P. Leão & J. Correia-Pinto

  3. ICVS/3B’s - PT Government Associate Laboratory, Braga, Guimarães, Portugal

    P. Leão & J. Correia-Pinto

  4. Department of General Surgery, de Gaia Hospital, Vila Nova de Gaia, Portugal

    N. Marcos

  5. Department of General Surgery, La Mancha Center Hospital, Alcazar de San Juan, Spain

    C. Moreno-Sanz

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  1. P. Leão
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  2. A. Goulart
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  3. C. Veiga
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  4. H. Cristino
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Corresponding author

Correspondence to P. Leão.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

No ethical approval was required by our institution.

Informed consent

The procedure and consequences were explained to all of the patients, and written informed consent was obtained. Patients also gave permission for publication of technique and results.

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Leão, P., Goulart, A., Veiga, C. et al. Transanal total mesorectal excision: a pure NOTES approach for selected patients. Tech Coloproctol 19, 541–549 (2015). https://doi.org/10.1007/s10151-015-1343-0

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  • DOI: https://doi.org/10.1007/s10151-015-1343-0

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