Article
Transrectal Single Port Approach: An alternative to NOTES, TEM or ESD
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Published: | April 23, 2012 |
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Introduction: For the past 25 years development of both, transanal and endoscopic techniques for resection of local tumours in the rectum have been established. The technique of single port surgery allows an alternate approach utilizing laparoscopic instruments for endolumenal colonic tumour resection. Herein we present the technical aspects of this novel method.
Materials and methods: From November 2010 on we operate on five patients suffering from benign tumours in the mid and low rectum. In all cases endoscopic snare resection was not feasible for length and orientation of the lesion. Patients were placed in lithotomy position and a SILS port (Covidien) was fixed transanally. Using intralumenal carbon-dioxide insufflation, two working instruments and a five millimetre 30° camera were delivered through the port. Submucosal preparation was carried out by means of ultrasonic or monopolar electrocauteric dissection. Closure of the mucosal defect was necessary in one patient. Specimen were sent for pathohistological evaluation.
Results: All resections could be completed successfully, no intraoperative complication was observed. Entire continuity of dissection plane could be achieved. Histological evaluation revealed free resection margins, postoperative recovery of the patients were uneventful.
Conclusion: Transanal resection of large polyps using laparoscopic instruments can, in some cases, be a save and feasible alternative to NOTES, TEM, or ESD.