Background. Transanal endoscopic microsurgery (TEM) has been used for several decades for excision of neoplastic lesions in the rectum. With the development of natural orifice translumenal endoscopic surgery (NOTES) techniques, the authors describe a new method of proctectomy using a combination of TEM and NOTES principles. Methods. In a porcine model, a circumferential rectal sleeve resection was performed using TEM with flexible endoscopic assistance. The rectum was delivered through the anus, resected, and an end-to-end stapled anastomosis was performed. Results. The specimen was approximately 10 cm in length. No adjacent organ injuries or evidence of hemorrhage from the vascular pedicle or in the pelvis was observed at necropsy. Procedure time was 3 hours. Conclusion. This technique may increase the complexity of lesions accessible by TEM and may ultimately lead to the performance of total mesorectal excision using transanal techniques, reducing the morbidity of the abdominal approach.
Whitehouse PA , Tilney HS, Armitage JN, Simson JNTransanal endoscopic microsurgery: risk factors for local recurrence of benign rectal adenomas. Colorectal Dis. 2006;8:795-799.
3.
Schafer H., Baldus SE, Holscher AHGiant adenomas of the rectum: complete resection by transanal endoscopic microsurgery (TEM). Int J Colorectal Dis. 2006;21:533-537.
4.
Chen H., George BD, Kaufman HS, Malaki MB, Mortensen NJ, Kettlewell MGEndoscopic transanal resection provides palliation equivalent to transabdominal resection in patients with metastatic rectal cancer. J Gastrointest Surg. 2001;5:282-286.
5.
Heintz A., Morschel M., Junginger T.Comparison of results after transanal endoscopic microsurgery and radical resection for T1 carcinoma of the rectum. Surg Endosc. 1998;12:1145-1148.
6.
Ganai S., Kanumuri P., Rao RS, Alexander AILocal recurrence after transanal endoscopic microsurgery for rectal polyps and early cancers. Ann Surg Oncol. 2006;13: 547-556.
Maslekar S., Pillinger SH, Monson JRTransanal endoscopic microsurgery for carcinoma of the rectum. Surg Endosc. 2007;21:97-102.
9.
Zacharakis E. , Freilich S., Rekhraj S., et al. Transanal endoscopic microsurgery for rectal tumors: the St. Mary’s experience. Am J Surg . 2007;194:694-698.
10.
Saclarides TJTransanal endoscopic microsurgery. Surg Clin North Am. 1997;77:229-239.
11.
Whiteford MH , Denk PM, Swanstrom LLFeasibility of radical sigmoid colectomy performed as natural orifice translumenal endoscopic surgery (NOTES) using transanal endoscopic microsurgery. Surg Endosc. 2007 ;21: 1870-1874.
12.
Sylla P., Willingham FF, Sohn DK, Gee D., Brugge WR, Rattner DWNOTES rectosigmoid resection using transanal endoscopic microsurgery (TEM) with transgastric endoscopic assistance: a pilot study in swine. J Gastrointest Surg. 2008;12:1717-1723.
