gms | German Medical Science

Introduction: The treatment of rectal cancer is facing a paradigm shift in the last few years, with the impact of new endoscopic and neoadjuvant concepts. The new concept of Down-to-Up transanal TME resection using an adapted single port platform (TAMIS-transanal minimally invasive surgery) was first clinically introduced by the authors in 2009. The present study describes the technical aspects of transanal applications of Single Port for colorectal indications.

Methods: Transanal Single Port surgical resection combined with umbilical Single Port device was indicated for a series of patients with diagnosed rectal adenocarcinoma at middle and lower third of the rectum and also patients with rectal adenomas were submitted to transanal Single Port resection. Total mesorectal resection and rectosigmoidectomy was performed using single port device directly inserted inside the rectum, and dissection was progressed proximally using perirectal dissection. Specimens were extracted transanally, and stappled or sutured transorificial anastomosis was performed. Full thickness resection of large adenomas in middle and upper rectum was performed with transanal single port.

Results: All patients with middle and lower rectal cancer were submitted to Down-to-Up procedure. Operative time was a mean of 240 min for rectal resection with TME and a mean of 48 min for adenomas. There were 2 patients with postoperative leaks and treated by relaparoscopy or laparotomy. One patient had a rectal bleeding after transanal full-thickness resection. The postoperative course of the other patients at 30 days was uneventful.

Conclusion: The present study shows that transanal and transumbilical Single Port surgery are technically feasible in the routine basis. TAMIS can successfully replace many indications of previous TEM for benign disease. The technique can be performed with available technology and reduced learning curve.

Figure 1 [Fig. 1]