Minilaparoscopy-assisted natural orifice total colectomy: technical report of a minilaparoscopy-assisted transrectal resection

Lacy, Antonio M.; Saavedra-Pérez, David; Bravo, Raquel; Adelsdorfer, Cedric; Aceituno, Montserrat; Balust, Jaume

doi:10.1007/s00464-011-2117-z

Cited by 31 publications

(12 citation statements)

References 10 publications

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“…Concerns remain despite more recent studies[16,73], and high quality evidence in favor of a standard laparoscopic approach for its routine application to rectal cancer are still elusive. It is in this setting that trans-anal TME “down-to-up approach” was introduced[74,75]. Transanal TME is purported to confer distinct advantages of greater visibility, and a more complete mesorectal excision for mid and low rectal cancer patients, natural orifice specimen extraction with less post-operative pain and fewer wound complications.…”

Section: Minimally Invasive Surgerymentioning

confidence: 99%

Recent advances in the management of rectal cancer: No surgery, minimal surgery or minimally invasive surgery

Plummer

Leake

Albert

2017

WJGS

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Over the last decade, with the acceptance of the need for improvements in the outcome of patients affected with rectal cancer, there has been a significant increase in the literature regarding treatment options available to patients affected by this disease. That treatment related decisions should be made at a high volume multidisciplinary tumor board, after pre-operative rectal magnetic resonance imaging and the importance of total mesorectal excision (TME) are accepted standard of care. More controversial is the emerging role for watchful waiting rather than radical surgery in complete pathologic responders, which may be appropriate in 20% of patients. Patients with early T1 rectal cancers and favorable pathologic features can be cured with local excision only, with transanal minimal invasive surgery (TAMIS) because of its versatility and almost universal availability of the necessary equipment and skillset in the average laparoscopic surgeon, emerging as the leading option. Recent trials have raised concerns about the oncologic outcomes of the standard “top-down” TME hence transanal TME (TaTME “bottom-up”) approach has gained popularity as an alternative. The challenges are many, with a dearth of evidence of the oncologic superiority in the long-term for any given option. However, this review highlights recent advances in the role of chemoradiation only for complete pathologic responders, TAMIS for highly selected early rectal cancer patients and TaTME as options to improve cure rates whilst maintaining quality of life in these patients, while we await the results of further definitive trials being currently conducted.

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Section: Minimally Invasive Surgerymentioning

confidence: 99%

Recent advances in the management of rectal cancer: No surgery, minimal surgery or minimally invasive surgery

Plummer

Leake

Albert

2017

WJGS

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“…Technical developments have introduced extraction of the specimen through natural orifices and transanal MIS, which avoid extra incision and scar on the anterior abdominal wall. However, there is no robust data available on their application in the treatment of IBD [14] .…”

Section: Current Evidencesmentioning

confidence: 99%

Minimally invasive surgery for inflammatory bowel disease: Current perspectives

Shrestha

2016

WJGPT

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“…With improved transanal instruments and continued surgeon training, this pure NOTES approach will likely become more clinically applicable. refractory ulcerative colitis [150]. Three abdominal trocars were used in addition to a multiport transanal endoscopic platform.…”

Section: Conclusion and Future Perspectivementioning

confidence: 99%

Future directions in surgery for colorectal cancer: the evolving role of transanal endoscopic surgery

2014

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The current standard of care for resectable rectal cancers is total mesorectal excision (TME), which is usually performed open or laparoscopically, however, both techniques are associated with high morbidity and mortality.• Transanal endoscopic surgery (TES) is appropriate for benign rectal lesions and low-risk T1 tumors (Sm1; well differentiated; no lymphovascular or perineural invasion, and no tumor budding; <3 cm in size; <30% bowel circumference; and anticipated 3-mm clear margin).• Promising data support the use of neoadjuvant chemoradiation in making more lesions amenable to TES.• TES could potentially become favored over more radical surgery for preoperatively staged T2 tumors after neoadjuvant treatment.• Criteria for 'watch-and-wait' approaches are in flux because TES may have a role as a macrobiopsy for determining postneoadjuvant therapy T-stage, since long-term oncologic outcomes for TES are more related to ypT-stage rather than pretreatment T-stage.• Increasing data support transanal natural orifice translumenal endoscopic surgery (NOTES) TME as an acceptable alternative to open and laparoscopic TME, with regards to oncologic and functional outcomes.• Treatment paradigms including transanal NOTES to perform sentinel-node biopsies may provide more accurate staging, and potentially eliminate the need for TME in some cases.• Transanal NOTES TME should only be performed in carefully selected patients by surgeons with extensive experience with TES, laparoscopic TME and intersphincteric resection.SUMMARY The morbidity associated with radical surgery for rectal cancer has launched a revolution in increasingly less-invasive methods of resection, including a recent resurgence in transanal endoscopic surgical approaches. The next evolution in transanal surgery for rectal cancer is natural orifice translumenal endoscopic surgery (NOTES). To date, 14 series of transanal NOTES total mesorectal excision (TME) for rectal cancer have been published (n = 76).For reprint orders, please contact: reprints@futuremedicine.com

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Minilaparoscopy-assisted natural orifice total colectomy: technical report of a minilaparoscopy-assisted transrectal resection

Abstract: Transrectal MA-NOS total colectomy was feasible and safe in the reported case. Improvement in NOTES instrumentation and selective clinical applications are mandatory before clinical trials.

Cited by 31 publications

References 10 publications

Recent advances in the management of rectal cancer: No surgery, minimal surgery or minimally invasive surgery

Recent advances in the management of rectal cancer: No surgery, minimal surgery or minimally invasive surgery

Minimally invasive surgery for inflammatory bowel disease: Current perspectives

Future directions in surgery for colorectal cancer: the evolving role of transanal endoscopic surgery

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