Transanal Single-Port Surgery for the Resection of Large Polyps

Abstract

Introduction: Transanal endoscopic microsurgery (TEM) is widely used for the excision of both benign and malignant rectal tumours. It is relatively expensive and can be a challenging technique. A recent development in laparoscopic surgery is the single-port technique (single-incision laparoscopic surgery, SILS). The SILS port is a flexible multichannel port for transumbilical laparoscopic surgery. Even though not developed for transanal use the port could be ideal because of its shape and texture. Methods: 12 patients underwent transanal resection using an SILS port and normal laparoscopic instruments. Results: 10 out of 12 patients were treated successfully with the SILS port. Two polyps were resected using an open transanal technique because the distance between the SILS port and the polyp was too small. The average operative time was 55 min (range 40–80 min). All patients could be discharged on the first postoperative day. There were no major complications. Conclusion: Our current data show that transanal surgery using a single port is a relatively easy procedure with operative times comparable to TEM. More surgeons will therefore be able to perform transanal endoscopic surgery.

Impact of tumor location on lymph node metastasis in T1 colorectal cancer

“…Based on our study data, T1 colon cancer affects older patients and has smaller sizes compared to T1 rectal cancer and overall risk of lymph node metastasis is lowest in patients older than 80 years. Elderly patients who cannot tolerate major abdominal surgery are the potential candidates for a local excision [17]. The T1 cancers with lymph node metastasis in the colon and rectum had similar characteristics including tumor size, tumor differentiation, and lymphovascular invasion.…”

Transanal minimally invasive surgery (TAMIS) with a GelPOINT® Path for lower rectal cancer as an alternative to transanal endoscopic microsurgery (TEM)

“…Currently, the excision of rectal tumors by TEM is associated with fewer surgery-associated morbidities, an improved postoperative anorectal function and a shortened postoperative recovery when compared with open or laparoscopic rectal resections (8,9). Frail elderly patients, patients who are otherwise not suitable candidates for a major rectal resection, and patients who categorically refuse to undergo a radical rectal excision with permanent stoma creation for early-stage rectal cancer, are candidates for TAE (17). The widespread uptake of TEM, however, has been slow, in part due to the surgeon being forced to work through a long rigid rectoscope, which limits triangulation and the subsequent manipulation of the instruments.…”

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

“…The visibility of the rectum is generally excellent. Lower lesions, nearby the dentate line, are not generally resectable by both TEM and TAMIS, being conventional local resection the most appropriate method indicated 7 . TAMIS, when compared to TEM, does not allow access to higher rectal lesions (15 to 20 cm versus 18 to 25 cm).…”

“…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.…”