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NOTES transanal rectal cancer resection using transanal endoscopic microsurgery and laparoscopic assistance

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Abstract

Background

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.

Methods

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.

Results

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.

Conclusions

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.

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Authors and Affiliations

  1. Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA

    Patricia Sylla & David W. Rattner

  2. Department of Gastrointestinal Surgery, Hospital Clínic, CIBERehd, IDIBAPS, Centro de Investigaciones Biomédicas Esther Koplowitz, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain

    Salvadora Delgado & Antonio M. Lacy

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  1. Patricia Sylla
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  2. David W. Rattner
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  3. Salvadora Delgado
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  4. Antonio M. Lacy
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Correspondence to Antonio M. Lacy.

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Sylla, P., Rattner, D.W., Delgado, S. et al. NOTES transanal rectal cancer resection using transanal endoscopic microsurgery and laparoscopic assistance. Surg Endosc 24, 1205–1210 (2010). https://doi.org/10.1007/s00464-010-0965-6

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  • DOI: https://doi.org/10.1007/s00464-010-0965-6

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