Skip to main content

Advertisement

SpringerLink
Log in

Transanal single-port laparoscopic total mesorectal excision in the treatment of rectal cancer

  • Technical Note
  • Published:
Techniques in Coloproctology Aims and scope Submit manuscript

Abstract

Our objective was to report of our first experience with transanal total mesorectal excision (TME) of rectal cancer using single-port equipment, a pure natural orifice transluminal endoscopic surgery (NOTES) procedure, and to discuss the advantages and disadvantages of the technique. A patient with rectal cancer was selected according to preoperative evaluation criteria. Purse-string sutures were placed into the rectum distal to the tumor using the procedure of prolapse and hemorrhoids (PPH) anoscope. A full-thickness incision of the rectal wall was made circumferentially below the purse string and a three-channel cannula was inserted. The artificial orifice was insufflated. The entire mesorectum was dissected upward according to the principles of TME. Pneumoperitoneum was created by opening the rectouterine pouch. The sigmoid colon and its mesentery were dissected, and the inferior mesenteric vessels were ligated and divided. After dissection of a sufficient length of sigmoid colon, the PPH anoscope and the three-channel cannula were removed. The rectum and sigmoid colon were brought out through the anus. The tumor was resected. After removal of the specimens, a stapled end-to-end anastomosis was fashioned between the rectum and the sigmoid colon. Operative time was 300 min. The mesorectum was completely removed with negative distal and circumferential margin. The final pathological stage was pT3N1M0, with one positive lymph node (1/12). The patient recovered uneventfully after surgery. Pure-NOTES performed as transanal single-port laparoscopic TME for rectal cancer appears to be feasible and safe.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8

References

  1. Sylla P, Delgado S (2010) NOTES transanal rectal cancer resection using transanal endoscopic microsurgery and laparoscopic assistance. Surg Endosc 24:1205–1210

    Article  PubMed  Google Scholar 

  2. Chen Y, Hu M, Lei J et al (2010) Transanal endoscopic total mesorectal excision in the treatment of rectal cancer. China J Endosc 16:1261–1265

    Google Scholar 

  3. Fajardo AD, Hunt SR, Fleshman JW, Mutch MG (2010) Video. Transanal single-port low anterior resection in a cadaver model. Surg Endosc 24:1765

    Article  PubMed  Google Scholar 

  4. Bhattacharjee HK, Kirschniak A, Storz P et al (2011) Transansl endoscopic microsurgery-based transanal access for colorectal surgery: experience on human cadavers. J Laparoendosc Adv Surg Tech A 21:835–840

    Article  PubMed  Google Scholar 

  5. Kalloo AN, Singh VK, Jagannath SB et al (2004) Flexible transgastric peritoneoscopy: a novel approach to diagnostic and therapeutic interventions in the peritoneal cavity. Gastrointest Endosc 60:114–117

    Article  PubMed  Google Scholar 

  6. Marescaux J, Dallemagne B, Perretta S, Wattiez A, Mutter D, Coumaros D (2007) Surgery without scars: report of transluminal cholecystectomy in a human being. Arch Surg 142:823–826

    Article  PubMed  Google Scholar 

  7. Rattner D, Kalloo A, ASGE/SAGES Working Group (2006) ASGE/SAGES Working Group on natural orifice translumenal endoscopic surgery. October 2005. Surg Endosc 20:329–333

    Article  Google Scholar 

  8. Zorron R, Palanivelu C, Galvao Neto MP et al (2010) International multicenter trial on clinical natural orifice surgery. NOTES IMTN study: preliminary results of 362 patients. Surg Innov 17:142–158

    Article  PubMed  Google Scholar 

  9. Bucher P, Pugin F, Ostermann S, Ris F, Chilcott M, Morel P (2011) Population perception of surgical safety and body image trauma: a plea for scarless surgery? Surg Endosc 25:408–415

    Article  PubMed  Google Scholar 

  10. Froghi F, Sodergren MH, Darzi A, Paraskeva P (2010) Single-incision Laparoscopic Surgery (SILS) in general surgery: a review of current practice. Surg Laparosc Endosc Percutan Tech 20:191–204

    Article  PubMed  Google Scholar 

  11. Ahmed K, Wang TT, Patel VM et al (2011) The role of single-incision laparoscopic surgery in abdominal and pelvic surgery: a systematic review. Surg Endosc 25:378–396

    Article  PubMed  Google Scholar 

  12. Ross H, Steel S, Whiteford M et al (2011) Early multi-institution experience with single-incision laparoscopic colectomy. Dis Colon Rectum 54:187–192

    Article  PubMed  CAS  Google Scholar 

  13. Wang F, Jiang Z, Li J (2010) Application of single-port laparoscopic technique in the gastric and colorectal surgeries. Chin J Practi Surg 30:501–502

    CAS  Google Scholar 

  14. Buess G, Theiss R, Hutterer F et al (1983) Transanal endoscopic surgery of the rectum—testing a new method in animal experiments. Leber Magen Darm 13:73–77

    PubMed  CAS  Google Scholar 

  15. Allaix ME, Arezzo A, Caldart M, Festa F, Morino M et al (2009) Transanal endoscopic microsurgery for rectal neoplasms: experience of 300 consecutive cases. Dis Colon Rectum 52:1831–1836

    Article  PubMed  Google Scholar 

  16. Guerrieri M, Baldarelli M, de Sanctis A, Campagnacci R, Rimini M, Lezoche E (2010) Treatment of rectal adenomas by transanal endoscopic microsurgery: 15 years’ experience. Surg Endosc 24:445–449

    Article  PubMed  Google Scholar 

  17. Cid RC, Perez JC, Elosua TG (2011) Transanal resection using a single port trocar: a new approach to NOTES. Cir Esp 89:20–23

    Article  PubMed  Google Scholar 

Download references

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Department of General Surgery, Dongguan Kanghua Hospital, 1000 Dongguan Avenue, Dongguan, 523080, Guangdong, People’s Republic of China

    H. Zhang, Y.-S. Zhang, X.-W. Jin, M.-Z. Li, J.-S. Fan & Z.-H. Yang

Authors
  1. H. Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Y.-S. Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. X.-W. Jin
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. M.-Z. Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. J.-S. Fan
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Z.-H. Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to H. Zhang.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Zhang, H., Zhang, YS., Jin, XW. et al. Transanal single-port laparoscopic total mesorectal excision in the treatment of rectal cancer. Tech Coloproctol 17, 117–123 (2013). https://doi.org/10.1007/s10151-012-0882-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10151-012-0882-x

Keywords

Search

Navigation