Perirectal NOTES Access

Zorrón, Ricardo; Phillips, Henrique Neubarth; Coelho, Djalma Ernesto; Flach, Luciana; Lemos, Fabiano Batista; Vassallo, Ricardo Cortez

doi:10.1177/1553350611409956

Cited by 73 publications

(11 citation statements)

References 53 publications

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“…[35] Our group described experimental studies in a swine model in a period of 10 months before human applications using flexible transrectal dissection, resection and anastomosis with survival, and human casuistic starting in 2009. [363738] Differences of our technique of transanal retrograde NOTES TME to these previous works is the absence of use of TEM devices and the employment of flexible dissection and single port access platform, thus allowing freedom for more creative dissection methods. Single access devices are also universally available and promotes an easy learning curve because its similarity with laparoscopic manipulation, in contrast to flexible dissection and TEM.…”

Section: Discussionmentioning

confidence: 99%

"Down-to-Up" transanal NOTES Total mesorectal excision for rectal cancer: Preliminary series of 9 patients

et al. 2014

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BACKGROUND:Applications for natural orifice translumenal endoscopic surgery (NOTES) to access the abdominal cavity have increased in recent years. Despite potential advantages of transanal and transcolonic NOTES for colorectal pathology, it has not been widely applied in the clinical setting. This study describes a series of nine patients for whom we performed transanal retrograde (“Down-to-Up”) total mesorectal excision for rectal cancer.MATERIALS AND METHODS:Under IRB approval, informed consent was obtained from each patient with rectal adenocarcinoma. Rectosigmoidectomy with total mesorectal excision was performed using low rectal translumenal access to the mesorectal fascia and subsequent dissection in a retrograde fashion. This was achieved using either a single port device or flexible colonoscope with endoscopic instrumentation and laparoscopic assistance. This was followed by transanal extraction of the specimen and hand-sewn anastomosis.RESULTS:Mean operative time was 311 min. Mean hospital stay was 7.56 days. Complications occurred in two patients, and consisted of one anastomotic leakage with reoperation and one intraoperative conversion to open surgery because of impossibility to dissect the specimen. TME specimen integrity was adequate in six patients.CONCLUSION:This series suggests that a retrograde mesorectal dissection via a NOTES technique is feasible in patients with rectal adenocarcinoma. This technique may act as a complimentary part of operative treatment for rectal cancer alongside other minimally invasive strategies. Long-term follow up will be needed to assess oncological results.

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Section: Discussionmentioning

confidence: 99%

"Down-to-Up" transanal NOTES Total mesorectal excision for rectal cancer: Preliminary series of 9 patients

et al. 2014

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“…Zorron et al 4 and Sylla et al 3 proposed a novel “bottom-up” approach. The rectal dissection is performed by the NOTES approach, using the TAMIS technique, coupled with hybrid multiport laparoscopy for sigmoid mobilization.…”

Section: Discussionmentioning

confidence: 99%

“…Recently a NOTES “bottom-up” approach for rectal dissection has been described. 3 , 4 This is a hybrid technique with multiport laparoscopy and NOTES mobilization of the rectum. The rectal dissection is performed through a transanal platform: this technique has also been named transanal minimally invasive surgery (TAMIS).…”

Section: Introductionmentioning

confidence: 99%

Transanal Total Mesorectal Excision With Single-Incision Laparoscopy for Rectal Cancer

Foo

Choi

Wei

et al. 2016

JSLS

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Background and Objectives:There has been great enthusiasm for the technique of transanal total mesorectal excision. Coupled with this procedure, we performed single-incision laparoscopic surgery for left colon mobilization. This is a description of our initial experience with the combined approach.Methods:Patients with distal or mid rectal cancer were included. The operation was performed by 2 teams: one team performed the single-incision mobilization of the left colon via the right lower quadrant ileostomy site, and the other team performed the total mesorectal excision with a transanal platform.Results:During the study period, 10 patients (5 men) with cancer of the rectum underwent the surgery. The mean age was 62.2 ± 11.1 years, and the mean body mass index was 23.4 ± 3.2 kg/m2. The tumor's mean distance from the anal verge was 5.1 ± 2.5 cm. The median operating time was 247.5 minutes (range, 188–462 minutes). The mean estimated blood loss was 124 ± 126 mL (range, 10–188 mL). Conversion to multiport laparoscopy was needed in one case (10%). Postoperative pain, as reflected by the pain score, was minimal. The mean number of lymph nodes harvested was 15.6 ± 3.8. All specimens had clear distal and circumferential radial margins. The overall complication rate was 10%.Conclusion:Our experience showed transanal total mesorectal excision with single-incision laparoscopy to be a feasible option for rectal cancer. Patients reported minimal postoperative pain. Further studies on the long-term outcome are warranted.

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“…Perirectal NOTES access: "down-to-up" total mesorectal excision for rectal cancer (Zorron et al, Surg Innov 2011 [9]) ! The transrectal approach for NOTES appears to be the least favored entry route.…”

Section: Dissection Of Only the Inner Circular Muscle Layer And Slingmentioning

confidence: 99%

Natural orifice transluminal endoscopic surgery (NOTES)

Meining

2012

Endoscopy

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Perirectal NOTES Access

Abstract: Successful human reports on transcolonic NOTES suggest potential applications. The treatment of colorectal diseases through transorificial single port or flexible perirectal NOTES access are promising new approaches besides current methods to improve patient care.

Cited by 73 publications

References 53 publications

"Down-to-Up" transanal NOTES Total mesorectal excision for rectal cancer: Preliminary series of 9 patients

"Down-to-Up" transanal NOTES Total mesorectal excision for rectal cancer: Preliminary series of 9 patients

Transanal Total Mesorectal Excision With Single-Incision Laparoscopy for Rectal Cancer

Natural orifice transluminal endoscopic surgery (NOTES)

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