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.

The sign of Leser-Trélat (LT) is defined as the sudden eruption of multiple seborrhoeic keratoses (SKs), or increase in the number and size of existing SKs, associated with an underlying malignancy. A 75-year-old man was admitted to our hospital with dyspnoea and multiple verrucous papules that had been developing gradually over the previous 30 years. During the 3 months before presentation, the number of SKs on his chest and back had increased rapidly. A diagnosis of nasopharyngeal carcinoma was made based on results of computed tomography, endoscopy and biopsy examinations. The patient is receiving radiotherapy at present. To our knowledge, this is the first case of the Leser-Trélat sign associated with nasopharyngeal carcinoma.