Transanal minimally invasive surgery with single-port laparoscopy for rectal tumors

Rega, Daniela; Cardone, E.; Montesarchio, Luca; Tammaro, Pasquale; Pace, Ugo; Ruffolo, F.; Franciscis, Silvia De; Belli, Andrea; Bianco, Francesco; Delrio, Paolo

doi:10.1016/j.ejso.2012.07.028

Cited by 5 publications

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“…67,68 More recently, transanal minimally invasive surgery (TAMIS), a newer technique that utilizes flexible and disposable transanal endoscopic platforms and accommodates traditional laparoscopic instruments, has accelerated the popularity of transanal endoscopic surgery worldwide. [69][70][71][72] Inherent limitations of TEM and TAMIS apply to all local excision techniques, namely the lack of mesorectal clearance with prohibitively high recurrence rates when used to resect T2 and more advanced rectal tumors. As a result, TEM and TAMIS are only indicated for resection of benign rectal lesions and carefully selected T1 rectal tumors with low-risk features, as local recurrence rates for those lesions after TEM are similar to rates after TME.…”

Section: Evolution Of Transanal Approaches To Rectal Surgerymentioning

confidence: 99%

Shifting Paradigms in Minimally Invasive Surgery: Applications of Transanal Natural Orifice Transluminal Endoscopic Surgery in Colorectal Surgery

Lee

Sylla

2015

Clinics in Colon and Rectal Surgery

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Though adoption of the surgical principles of total mesorectal excision (TME) in combination with chemoradiation for locally advanced disease has continued to improve local control and survival rates of resectable rectal cancer, radical resection continues to be associated with high morbidity and mortality.1,2 Standard multiport and robotic-assisted laparoscopy, although oncologically safe and associated with shorter length of hospital stay (LOS) than open resections, have not had a measurable impact on the incidence of postoperative complications, sexual and urinary dysfunction, AbstractSince the advent of laparoscopy, minimally invasive techniques such as single port laparoscopy, robotics, endoscopically assisted laparoscopy, and transanal endoscopic surgery continue to revolutionize the field of colorectal surgery. Transanal natural orifice transluminal endoscopic surgery (NOTES) represents a further paradigm shift by combining the advantages of these earlier techniques to reduce the size and number of abdominal incisions and potentially optimize rectal dissection, especially with respect to performance of an oncologically adequate total mesorectal excision (TME) for rectal cancer. Since the first experimental report of transanal rectosigmoid resection in 2007, the potential impact of transanal NOTES in colorectal surgery has been extensively investigated in experimental models and recently transitioned to clinical application. There have been 14 clinical trials of transanal TME (taTME) for rectal cancer that have demonstrated the feasibility and preliminary oncologic safety of this approach in carefully selected patients, with results comparable to outcomes after laparoscopic and open TME, including cumulative intraoperative and postoperative complication rates of 5.5 and 35.5%, respectively, 97.3% rate of complete or near-complete specimens, and 93.6% rate of negative margins. Transanal NOTES has also been safely applied to proctectomy and colectomy for benign indications. The consensus among published series suggests that taTME is most safely performed with transabdominal assistance by surgeons experienced with laparoscopic TME, transanal endoscopic surgery, and sphincter-preserving techniques including intersphincteric resection. Future applications of transanal NOTES may include evolution to a pure endoscopic transanal approach for TME, colectomy, and sentinel lymph node biopsy for rectal cancer, with a potential role for robotic assistance.

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