Single-Port Transanal Surgery of a Giant Rectal Adenoma

Abstract

Introduction:

Transanal endoscopic microsurgery (TEM) is currently widely accepted as the standard surgical method for the resection of large rectal adenomas and selected rectal carcinomas. The technique is unique for its purpose and has proven to be safe and effective. ^1,2 The rapid development of new instrumentation for minimally invasive surgery has led to multiport devices, requiring only single incision, which have already facilitated a broad spectrum of abdominal procedures. ^{3 –5} Single-port surgery of rectal tumors may be associated with shorter learning curve and less costs than TEM. Few cases of single-port transanal surgery are known. ^{6 –8} We present a case in which a giant rectal adenoma was resected using a single-site access system transanally.

Materials and Methods:

Under general anesthesia, a semicircumferent adenoma located 6–12 cm from the anus was resected using a single-site access system transanally in a 43-year-old otherwise healthy woman. Bowel preparation consisted of a single enema 1 h preoperatively, and peroperative antibiotics (cefazoline/metronidazol) were administered. A high-definition 30° laparoscope, standard laparoscopic instrumentation, harmonic shear, and continuous self-anchoring sutures were used.

Results and Conclusions:

Endoluminal features were comparable to TEM. Full-thickness en bloc resection was possible with complete margins. The defect was sutured transversally with continuous self-anchoring sutures. Operating time was 55 min. No blood loss or peroperative complications occurred. The patient was discharged in good clinical condition after overnight observation. Histopathology revealed tubulovillous adenoma with focal high-grade dysplasia, radically resected. Single-port transanal surgery may become an alternative to TEM.

No competing financial interests exist.

Runtime of video: 7 mins 16 secs