Hybrid NOTES: TEO for transanal total mesorectal excision: intracorporeal resection and anastomosis

Abstract

The introduction of technical variants of TEO for transanal resection can facilitate a procedure that requires extensive experience in transanal and laparoscopic surgery. Studies of sphincter function, quality of life, and long-term oncological outcome are now necessary.

Initial experience of transanal total mesorectal excision with rigid or flexible transanal platforms in cadavers

“…This was due to the angulation of the proctoscope (7), incomplete (2) Bleeding (2), rectal perforation (3) Surg Endosc at 70°and the camera for TEM, which was more suitable for transanal local excision than it was for circumferential dissection of the rectum. The differences between TEM and TEO proctoscopes were documented in a recent report by Serra-Aracil et al as well [19]. The SILS Port platform, a flexible transanal platform, was first introduced in a study by Matz et al [26].…”

“…Denk et al [15] also concluded, from their transrectal NOTES experience involving three porcine and three cadaveric models, that TEM was feasible for transanal NOTES. The usefulness of TEO platforms for transanal TME has also been well documented in animal and cadaveric studies [5,6,11,14], as well as in human clinical trials [17][18][19][20]24] (Table 2). …”

“…The mean operation time was 146.3 (range 140-155) min with flexible platforms and 206.7 (range 150-260) min with rigid platforms. The mean specimen length was 23 (range [18][19][20][21][22][23][24][25][26] cm. Complete or nearly complete mesorectal specimens were obtained in all cases, except for one case using the TEM platform.…”

“…Because of limitations in the transanal platforms and instruments, the majority of recent taTME studies reported that taTME was used as an augmentation of laparoscopic low anterior resection (LAR) rather than as exclusive taTME [1,[18][19][20][21][22][23]. taTME combined with laparoscopic abdominal assistance, Hybrid NOTES TME, could provide solutions to some of the limitations associated with laparoscopic rectal surgeries, because the down-to-up approach provides a better view of the TME plane and provides some potential benefits to patients with narrow pelvises, obesity, and/or bulky, low-lying tumors.…”

Laparo-endoscopic Transanal Total Mesorectal Excision (TATME): evidence of a novel technique

“…These patients were enrolled in 33 publications according to three types of clinical studies: case reports (17,(19)(20)(21)(22), clinical case series (retrospective and prospective) (11,(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)42), and comparative studies (43)(44)(45)(46)(47)(48)(49).…”