Transanal colorectal resection using natural orifice translumenal endoscopic surgery (<scp>NOTES</scp>)

Emhoff, Isha; Lee, Grace C.; Sylla, Patricia

doi:10.1111/den.12157

Cited by 56 publications

(38 citation statements)

References 121 publications

(299 reference statements)

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“…As in the present series, other reports4, 5, 6, 7, 8, 9, 10, 11 24, 25 have described the absence of intra‐abdominal infection.…”

Section: Discussionsupporting

confidence: 83%

“…Since the first transgastric liver biopsy by Kalloo and colleagues1, there has been continued interest in natural orifice transluminal endoscopic surgery (NOTES)2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14. For colorectal cancer, most operations have been hybrid procedures4, 5, 6, 7, 8, 9, 10 with few reports11, 12, 13, 14 confined to NOTES alone.…”

Section: Introductionmentioning

confidence: 99%

“…For colorectal cancer, most operations have been hybrid procedures4, 5, 6, 7, 8, 9, 10 with few reports11, 12, 13, 14 confined to NOTES alone. In colorectal cancer surgery, potential benefits of NOTES might include less pain, avoidance of incisional infection, shorter hospital stay, better cosmesis and high‐quality oncological resection by transanal total mesorectal excision (TME)4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14.…”

Section: Introductionmentioning

confidence: 99%

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Natural orifice transluminal endoscopic surgery for colorectal cancer

Thien

Thanh

et al. 2017

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BackgroundNatural orifice transluminal endoscopic surgery (NOTES) has theoretical advantages over other approaches.MethodsThis was a prospective cohort study of colorectal cancers operated on by NOTES (transanally for rectal tumours, transvaginally for sigmoid tumours) between December 2013 and December 2015, with a minimum follow‐up of 1 year. Eligibility criteria included ASA fitness grade I–III, BMI below 25 kg/m2 and TNM stage T3 N0 M0. Exclusion criteria included pregnancy or distant metastasis. The anastomosis was either handsewn or performed mechanically.ResultsSixteen patients were operated on by a transanal and four by a transvaginal approach. There were ten men and ten women, with a mean(s.d.) age of 55·6(12·1) years. Mean BMI was 22·4(2·6) kg/m2. Four anterior, 11 low anterior and five intersphincteric resections were performed for 16 rectal and four low sigmoid tumours. The mean duration of surgery was 258(11) min. No conversion to laparotomy was needed, and there were no deaths. Five patients required additional ports, for intraoperative bleeding (1), suture of an intraoperative urethral injury with covering ileostomy (1) and difficulty in dissection (3). One patient had an anastomotic leak requiring transanal closure and ileostomy on day 7. Both ileostomies were closed after 2 months. The mean hospital stay was 6·4(1·8) days. All resections were R0.ConclusionIn carefully selected patients NOTES for colorectal cancer resection was feasible and effective.

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“…As in the present series, other reports4, 5, 6, 7, 8, 9, 10, 11 24, 25 have described the absence of intra‐abdominal infection.…”

Section: Discussionsupporting

confidence: 83%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Natural orifice transluminal endoscopic surgery for colorectal cancer

Thien

Thanh

et al. 2017

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confidence: 99%

Transanal total mesorectal excision: full steam ahead

Atallah¹

2015

Tech Coloproctol

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The article by Araujo [1] in this month's issue documents the dramatic climb of transanal total mesorectal excision (transanal TME) with the most comprehensive review on this topic to date and a revelation of published numbers that are approximately double what they were just 1 year ago [2]. While it may seem as if transanal TME materialized overnight, in actuality, its foundation had been quietly in development for three decades. The seeming sudden ascent of transanal TME is analogous to a building under construction. Developing a proper foundation is a time-intensive and critical first step. To naïve observers of a construction site, it may appear as though no progress is underway, until the foundation is completed and suddenly a building begins to rise ten stories high, filling in the skyline with striking speed.The foundation for transanal TME began 30 years ago with the innovative efforts of Gerald Marks and later carried on with his son John Marks. In the early 1980s, G. Marks pioneered the technique of what he termed the transabdominal-transanal (TATA) operation for rectal cancers involving the distal one-third of the rectum [3], performing a meticulous dissection from below and adapting Bill Heald's concept of TME, albeit 'in reverse.' This predated the era of laparoscopy and the first TATA operations were completed with an open approach before transitioning to the use of laparoscopic assistance in the 1990s [4]. For 30 years, Marks' TATA operation laid down the foundation for modern transanal TME, spelling out very clearly why this approach was preferred for distal rectal cancer. Principally, the advantages of TATA were (a) definition of the distal margin from below, thereby assuring no tumor involvement at the line of distal division and (b) obviating the need for stapling devices for transection, which do not comply with boney constraints ofin particular-the narrow male pelvis. Even when staplers could be negotiated into pelvic confines from above, there was still the risk of inadvertently stapling across tumor, thereby irreversibly compromising the oncologic integrity of the operation. While Marks' rationale behind TATA was perfectly on point, the technique required specialized retractors with limited exposure, and thus few were able to replicate this approach.In parallel with TATA, the transanal endoscopic microsurgery (TEM) scope was developed by Buess [5] and considerable experience was gained with TEM for local excision of rectal neoplasia, though primarily for nonmalignant lesions. TEM was, for many, an unaffordable privilege of the elite; most colorectal surgeons, to this day, are not privy to TEM nor have they had formal training with this exquisite device. TEM's penetration had remained limited due to prohibitive upfront costs and also the complexity it mandates from surgeons.During a recent lectureship webcast, a renowned colorectal surgeon remarked that, 'in [the year] 2000, TEM was dead.' This statement was not intended to discredit the otherwise precocious TEM marvel. Implicit, however,...

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“…33 In this series, 20 % of patients had complications: two with urinary retention, one with ileus, and one with dehydration. In total, 72 patients have been reported in the literature (reviewed in 34 ), but no long-term oncologic outcomes are available. As with APPEAR, transanal TME has the potential to improve the perineal aspect of the dissection and achieve a sphincter-sparing R 0 resection in more patients with low rectal cancer, but further study is necessary to evaluate long-term oncologic outcomes.…”

Section: Transanal Tmementioning

confidence: 99%

Sphincter-Sparing Surgery in Patients with Low-Lying Rectal Cancer: Techniques, Oncologic Outcomes, and Functional Results

Bordeianou

Maguire

Alavi

et al. 2014

Journal of Gastrointestinal Surgery

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Background Rectal cancer management has evolved into a complex multimodality approach with survival, local recurrence, and quality of life parameters being the relevant endpoints. Surgical treatment for low rectal cancer has changed dramatically over the past 100 years. Discussion Abdominoperineal resection, once the standard of care for all rectal cancers, has become much less frequently utilized as surgeons devise and test new techniques for preserving the sphincters, maintaining continuity, and performing oncologically sound ultra-low anterior or local resections. Progress in rectal cancer surgery has been driven by improved understanding of the anatomy and pathophysiology of the disease, innovative surgical technique, improved technology, multimodality approaches, and increased appreciation of the patient's quality of life. The patient with a low rectal cancer, once almost universally destined for impotence and a colostomy, now has the real potential for improved survival, avoidance of a permanent stoma, and preservation of the normal route of defecation.Keywords Rectal cancer . Sphincter preservation . Total mesorectal excision . Anterior resection . Intersphincteric resection . Local excision rectal cancer Historical BackgroundThe modern era of rectal cancer surgery began with the description of the abdominoperineal resection (APR) by Miles in 1908. Prior perineal and sacral approaches (e.g., Kraske approach) to rectal cancer resection produced high rates of complications, cancer recurrence, poor quality of life (QOL), and poor overall survival. Miles' operation reflected greater understanding of the natural history of rectal cancer that was based on postmortem examination of his patients after perineal resection. He observed cancerous implants in the pelvic peritoneum, mesorectum, and affected nodes of the left common iliac bifurcation. These findings led him to develop a "cylindrical concept" of the spread of rectal cancer to upward, downward, and lateral zones. 1 The original operation included resection of the rectum, sigmoid, mesorectum, nodes of the iliac bifurcation, and a perineal component to include the anus and levator ani muscles. Postoperative mortality was high initially, but local recurrence decreased

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Transanal colorectal resection using natural orifice translumenal endoscopic surgery (NOTES)

Cited by 56 publications

References 121 publications

Natural orifice transluminal endoscopic surgery for colorectal cancer

Natural orifice transluminal endoscopic surgery for colorectal cancer

Transanal total mesorectal excision: full steam ahead

Sphincter-Sparing Surgery in Patients with Low-Lying Rectal Cancer: Techniques, Oncologic Outcomes, and Functional Results

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