Transanal Excision of a Rectal Adenoma Using Single-Access Laparoscopic Port

Abstract

Many rectal tumors can be excised transanally using inexpensive equipment. Transanal endoscopic microsurgery allows excision of lesions beyond the reach of conventional technique. Transanal endoscopic microsurgery is performed with specialized expensive instruments. Surgeons working in smaller community hospitals lack the budget to purchase transanal endoscopic microsurgery instruments. I modified the transanal endoscopic microsurgery technique by using a single-incision laparoscopic port that was inserted into the anal canal. Through this port, insufflation with gas maintained exposure of the surgical site, a 30-degree 5-mm camera, a grasper, and electrocautery were used to remove a large villous adenoma. This is the first report of the use of a single-access port to perform transanal endoscopic microsurgery. This modification is inexpensive compared with traditional transanal endoscopic microsurgery and allows more surgeons to perform difficult transanal tumor excisions (see Video, Supplemental Digital Content 1, http://links.lww.com/DCR/A39).

Transanal single port access to facilitate distal rectal mobilization in laparoscopic rectal sleeve resection with hand-sewn coloanal anastomosis

“…Experimental reports of preclinical and clinical practice showed feasibility and possible technical problems of implementing NOTES in colorectal surgery [5]. Different groups reported on new surgical techniques, and with the introduction of single port surgery, parallels with the well-established transanal endoscopic microsurgery (TEM) technique were drawn [6,7]. TEM equipment provides a stable platform for transanal access; recently, boundaries for its use have been extended, and new applications have been explored.…”

Transanal Single-Port Surgery for the Resection of Large Polyps

“…Limitations are the expensive equipment that is necessary and the fact that it remains a challenging procedure. Recently, a few case reports described a modified TEM technique replacing the TEM rectoscope with a single-access laparoscopic port [11,12,13]. The advantages of the SILS port are numerous.…”

Transanal minimally invasive surgery with single-port (TAMIS) for the management of rectal neoplasms: a pilot study

“…From the development of surgical techniques, such as Natural Orifice Transluminal Endoscopic Surgery (NOTES), and the use of single portal devices for laparoscopic surgery, a new alternative for resection of rectal lesions by transanal surgery called Transanal endoscopic microsurgery performed by single port (TAMIS) was introduced [1][2][3] , combining the TEM traditional technique with other instruments commonly used in laparoscopic surgery.…”

“…This technique has proven to be effective and safe in treating early rectal tumors and polyps. When compared with traditional techniques as local excision, TEM has the advantages of better visualization of the rectum, access to higher lesions and better ability to obtain clear margins with the possibility of excision without fragmentation of the surgical specimen [1][2][3][4][5][6][7][8][9][10][11][12][13] . The high cost of the equipment and surgical instruments added to the limited number of indications for its use, consequently, lead to a long learning curve.…”