Combined NOTES total mesorectal excision and single-incision laparoscopy principles for conservative proctectomy: a single-centre study

BackgroundLaparoscopic surgery changed the management of numerous surgical conditions. It was associated with many advantages over open surgery, such as decreased postoperative pain, faster recovery, shorter hospital stay and excellent cosmesis. Since two decades single-incision endoscopic surgery (SIES) was introduced to the surgical community. SIES could possibly result in even better postoperative outcomes than multi-port laparoscopic surgery, especially concerning cosmetic outcomes and pain. However, the single-incision surgical procedure is associated with quite some challenges.MethodsAn expert panel of surgeons has been selected and invited to participate in the preparation of the material for a consensus meeting on the topic SIES, which was held during the EAES congress in Frankfurt, June 16, 2017. The material presented during the consensus meeting was based on evidence identified through a systematic search of literature according to a pre-specified protocol. Three main topics with respect to SIES have been identified by the panel: (1) General, (2) Organ specific, (3) New development. Within each of these topics, subcategories have been defined. Evidence was graded according to the Oxford 2011 Levels of Evidence. Recommendations were made according to the GRADE criteria.ResultsIn general, there is a lack of high level evidence and a lack of long-term follow-up in the field of single-incision endoscopic surgery. In selected patients, the single-incision approach seems to be safe and effective in terms of perioperative morbidity. Satisfaction with cosmesis has been established to be the main advantage of the single-incision approach. Less pain after single-incision approach compared to conventional laparoscopy seems to be considered an advantage, although it has not been consistently demonstrated across studies.ConclusionsConsidering the increased direct costs (devices, instruments and operating time) of the SIES procedure and the prolonged learning curve, wider acceptance of the procedure should be supported only after demonstration of clear benefits.

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“…Six eligible studies investigating single access NOTES have been identified [164–169]. The total population consists of 249 patients.…”

Section: Resultsmentioning

confidence: 99%

European association for endoscopic surgery (EAES) consensus statement on single-incision endoscopic surgery

et al. 2019

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“…In our study, patient characteristics were as follows: 56.52% were male patients, 82.61% had ASA score 2, the median distance from anal verge was 52 mm, the median tumor size was 20 mm, 65.22% were at AJCC clinical stage III, 91.30% were at cT3, and 47.83% were at cN1; the characteristics of our patients were compatible with only one TaTME-SPLS study done in France. [18] Sixty percent of the patients had ISR because their tumor margins were close to dentate line of the anus. The mean operation time was 366 minutes.…”

Section: Resultsmentioning

confidence: 99%

“…[17] When TaTME was performed via the transanal platform, it was di cult to continue upward dissection to reach the descending colon or splenic exure. [17,18] So, the procedures of TaTME, including high ligation of the inferior mesenteric artery and vein and mobilization of the sigmoid colon, descending colon, and splenic exure colon were performed assisted by the traditional laparoscopic surgery or single-port laparoscopic surgery. [17,18] According to our knowledge, there were few case series reports on TaTME assisted by single-port laparoscopic surgery (TaTME-SPLS).…”

Section: Introductionmentioning

confidence: 99%

“…[17,18] So, the procedures of TaTME, including high ligation of the inferior mesenteric artery and vein and mobilization of the sigmoid colon, descending colon, and splenic exure colon were performed assisted by the traditional laparoscopic surgery or single-port laparoscopic surgery. [17,18] According to our knowledge, there were few case series reports on TaTME assisted by single-port laparoscopic surgery (TaTME-SPLS). [17,18] In the current study, we investigated the feasibility and short-term clinical outcomes of neoadjuvant CCRT followed by TaTME-SPLS in Asian patients with middle to lower third rectal adenocarcinoma.…”

Section: Introductionmentioning

confidence: 99%

“…[17,18] According to our knowledge, there were few case series reports on TaTME assisted by single-port laparoscopic surgery (TaTME-SPLS). [17,18] In the current study, we investigated the feasibility and short-term clinical outcomes of neoadjuvant CCRT followed by TaTME-SPLS in Asian patients with middle to lower third rectal adenocarcinoma. We also estimated the differences of TaTME-SPLS in Western and Eastern patients with middle to lower third rectal adenocarcinoma.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Neoadjuvant concurrent chemoradiotherapy followed by transanal total mesorectal excision assisted by single-port laparoscopic surgery for low-lying rectal adenocarcinoma: a single center study

Chen

Lin

et al. 2020

Preprint

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Purpose: To assess the feasibility and short-term outcomes of neoadjuvant chemoradiotherapy (CCRT) followed by transanal total mesorectal excision assisted by single-port laparoscopic surgery (TaTME-SPLS) for low-lying rectal adenocarcinoma.Methods and materials: A total of 23 patients with clinical stage II-III low-lying (from anal verge 0-8 cm) rectal adenocarcinoma who underwent neoadjuvant CCRT followed by TaTME-SPLS consecutively from December 2015 to December 2018, were enrolled into our study. Chi-squared testing and Student’s t testing were used to make parametric comparisons, and Fisher’s exact test or the Mann–Whitney U-test were used to make nonparametric comparisons.Results: Conversion rate in patients who underwent neoadjuvant CCRT followed by TaTME-SPLS was only 4%. The mean operation time was 366 minutes and the inter-sphincter resection (ISR) was done for 14 patients (60%). The mean number of lymph nodes harvested were 15. There was no surgical mortality, but the 30-day morbidity rate was 21% (5 patients were Clavien-Dindo I-II). Pathological complete response was 21.74% with 100% organ preservation and 100% clear distal margin after neoadjuvant CCRT followed by TaTME-SPLS. Conclusion: TaTME-SPLS would be highly successful in lymph node negative and low T stage of low-lying rectal cancer patients who had pathological complete remission or high percentage of partial remission after neoadjuvant CCRT.

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Natural orifice versus conventional mini-laparotomy for specimen extraction after reduced-port laparoscopic surgery for colorectal cancer: propensity score-matched comparative study

et al. 2021

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Combined NOTES total mesorectal excision and single-incision laparoscopy principles for conservative proctectomy: a single-centre study

Abstract: Combining an endoscopic transanal TME and a single laparoscopic ileostomy-site proctectomy is a promising minimally invasive approach for the treatment of low rectal cancer.

Cited by 13 publications

References 39 publications

European association for endoscopic surgery (EAES) consensus statement on single-incision endoscopic surgery

European association for endoscopic surgery (EAES) consensus statement on single-incision endoscopic surgery

Neoadjuvant concurrent chemoradiotherapy followed by transanal total mesorectal excision assisted by single-port laparoscopic surgery for low-lying rectal adenocarcinoma: a single center study

Natural orifice versus conventional mini-laparotomy for specimen extraction after reduced-port laparoscopic surgery for colorectal cancer: propensity score-matched comparative study

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