gms | German Medical Science

129. Kongress der Deutschen Gesellschaft für Chirurgie

Deutsche Gesellschaft für Chirurgie

24.04. - 27.04.2012, Berlin

Preliminary Clinical Experience on Transrectal NOTES Single Port for Rectal Resection and TME

Meeting Abstract

  • Ricardo Zorron - Klinikum Bremerhaven Reinkenheide, Allgemein-, Viszeral-, Thorax- und Gefäßchirurgie, Bremerhaven
  • Henrique Phillips - University Hospital Teresópolis HCTCO-FESO, Department of Surgery, Rio de Janeiro
  • Djalma Coelho - University Hospital Teresópolis HCTCO-FESO, Department of Surgery, Rio de Janeiro
  • Tido Junghans - Klinikum Bremerhaven Reinkenheide, Allgemein-, Viszeral-, Thorax- und Gefäßchirurgie, Bremerhaven

Deutsche Gesellschaft für Chirurgie. 129. Kongress der Deutschen Gesellschaft für Chirurgie. Berlin, 24.-27.04.2012. Düsseldorf: German Medical Science GMS Publishing House; 2012. Doc12dgch527

DOI: 10.3205/12dgch527, URN: urn:nbn:de:0183-12dgch5274

Published: April 23, 2012

© 2012 Zorron et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.


Outline

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Objectives: Natural orifice surgery has been applied for abdominal surgery in recent years, using either a transvaginal or a transgastric access to perform procedures. Despite potential advantages of using transcolonic NOTES to treat colorectal diseases, its application is still rare in the literature. The study describes new methods in human series of transcolonic NOTES access, using a new oncologic transrectal TME procedure for rectal cancer.

Methods: Surgical resection was indicated for 11 patients with diagnosed rectal adenocarcinoma at middle third of the rectum, and 3 patients with benign tumors. IRB approval was obtained at the institution for the study, and the patients signed informed consent. Total mesorectal resection and rectosigmoidectomy was performed using single port device directly inserted inside the rectum, and dissection was progressed proximally using intracolonic LESS dissection. Laparoscopic assistance was used for IMA ligation and left colon mobilization. Specimens were extracted transanally, and stappled or sutured transorificial anastomosis was performed.

Results: 11 patients were submitted to Transcolonic NOTES and TME. Operative time was a mean of 290min. One patient was converted to laparoscopic surgery and one to open surgery. One patient presented necrosis of the anastomosis and was reoperated. The postoperative course of the other patients at 30 days was uneventful, with resumption of oral diet on the second or third postoperative day. Adequate lymphnode count and free margins were obtained.

Conclusion: NOTES access for colorectal surgery is a promising new approach besides existing laparoscopic and open surgery to improve patient care. Transcolonic NOTES using transrectal single port devices is feasible and can be performed with available technology.