Transanal total mesorectal excision: a pure NOTES approach for selected patients

Leão, P.; Goulart, A.; Veiga, C.; Cristino, H.; Marcos, N.; Correia-Pinto, J.; Rodrigues, M.; Moreno-Sanz, C.
September 2015
Techniques in Coloproctology;Sep2015, Vol. 19 Issue 9, p541
Academic Journal
Background: The concept of natural orifice transluminal endoscopic surgery (NOTES) has stimulated the development of various 'incisionless' procedures. One of the most popular is the transanal approach for rectal lesions. The aims of this study were to report how we standardized NOTES technique for transanal mesorectal excision without abdominal assistance, discuss the difficulties and surgical outcomes of this technique and report its feasibility in a small group of selected patients. Methods: Three consecutive female patients underwent transanal NOTES rectal resection without transabdominal laparoscopic assistance for rectal lesions. Functional results were assessed with the Fecal Incontinence Quality of Life scale and the Wexner score. Results: The technical steps are described in details and complemented with a video. All procedures were completed without transabdominal laparoscopic help. The mesorectal plane was entirely dissected without any disruption, and distal and circumferential margins were tumor-free. No major complications were observed. Functional results show a significant impairment after surgery with improvement at 6 months to levels near those of the preoperative period. Conclusions: The performance and publication of NOTES procedures are subject to much discussion. Despite the small number of patients, this procedure appears feasible and can be accomplished maintaining fecal continence and respecting oncologic principles.


Related Articles

  • Single-incision laparoscopic low anterior resection for rectal cancer. Bulut, Orhan; Nielsen, Claus B. // International Journal of Colorectal Disease;Oct2010, Vol. 25 Issue 10, p1261 

    The article discusses the single-incision laparoscopic low anterior resection for rectal cancer. It examines two invasive techniques including the single-incision laparoscopic surgery (SILS) and natural orifice transluminal surgery (NOTES) which are evolving alternative methods. It proposes that...

  • Natural Orifice Translumenal Endoscopic Surgery (NOTES) Towards Brighter Future. Abbas, S.; Rizvi, R. // World Journal of Laparoscopic Surgery;Jan-Apr2010, Vol. 3 Issue 1, p19 

    In natural orifice translumenal endoscopic surgery (NOTES) intentional puncture of one of the viscera (e.g., stomach, rectum, vagina, and urinary bladder) is made and an endoscope is used to access the abdominal cavity and perform an intra-abdominal operation. Early studies focused on...

  • Role of Magnetic Anchors During Laparoendoscopic Single Site Surgery and NOTES. Raman, Jay D.; Scott, Daniel J.; Cadeddu, Jeffrey A. // Journal of Endourology;May2009, Vol. 23 Issue 5, p781 

    AbstractEvolution of minimally invasive techniques has generated an impetus in the surgical community to reduce the invasiveness of laparoscopic surgery. To achieve this goal, surgeons are either limiting the number of transabdominal trocars using laparoendoscopic single site surgery (LESS) or...

  • No-incision (NOTES) versus single-incision (single-port) surgery for access to sites of peritoneal carcinomatosis: a back-to-back animal study. Ladjici, Yamina; Pocard, Marc; Marteau, Philippe; Valleur, Patrice; Dray, Xavier // Surgical Endoscopy;Sep2012, Vol. 26 Issue 9, p2658 

    Background: Preoperative radiological diagnosis and evaluation of limited peritoneal carcinomatosis (PC) is suboptimal. Triangle laparoscopy is considered a noncarcinologic option due to the risk of tumoral spreading through the lateral ports into the abdominal wall muscles. Open surgery is...

  • Pure single-port laparoscopic surgery or mix of techniques? Liatsikos, Evangelos; Kyriazis, Iason; Kallidonis, Panagiotis; Do, Minh; Dietel, Anja; Stolzenburg, Jens-Uwe // World Journal of Urology;Oct2012, Vol. 30 Issue 5, p581 

    Purpose: Laparoendoscopic single-site surgery (LESS) has emerged in the recent years as an alternative approach to conventional laparoscopic surgery which is accompanied by additional advantages over laparoscopy. In this work we attempt to review the current literature and to investigate the...

  • 'No scar' small bowel resection in a survival porcine model using transcolonic NOTES and transabdominal approach. Dubcenco, Elena; Grantcharov, Teodor; Eng, Frank C. S.; Streutker, Catherine J.; Baxter, Nancy N.; Rotstein, Ori D.; Baker, Jeffrey P. // Surgical Endoscopy;Mar2011, Vol. 25 Issue 3, p930 

    Background: Fundamental techniques and essential tools for performing 'no scar' surgery still need to be developed. Our study was designed to evaluate the feasibility of performing small bowel resection by transcolonic NOTES and transabdominal approach using rigid laparoscopic and flexible...

  • Future Trend in Minimally Invasive Surgery: Single Port, Minilaparoscopy, and NOTES. Boni, Luigi; Curcillo, Paul G.; Perretta, Silvana // Minimally Invasive Surgery (20901445);2012, p1 

    An introduction is presented in which the editor discusses several reports within the issue on the topic of several trends in surgery including natural orifice transluminal endoscopic surgery (NOTES), single port surgery and minilaparoscopy.

  • 20th International Congress of the European Association for Endoscopic Surgery (EAES) Brussels, Belgium, 20-23 June 2012.  // Surgical Endoscopy;Apr2013 Supplement, Vol. 27, p167 

    The article presents abstracts on medical topics which include the use of natural orifice specimen extraction (NOSE) and intracorporeal anastomosis in wound complications, the steps for laparoscopic total mesorectal excision, and the partial splenectomy for benign disease.

  • Minilaparoscopy-assisted transrectal low anterior resection (LAR): a preliminary study. Lacy, Antonio; Adelsdorfer, Cedric; Delgado, Salvadora; Sylla, Patricia; Rattner, David // Surgical Endoscopy;Jan2013, Vol. 27 Issue 1, p339 

    Background: Natural orifice translumenal endoscopic surgery (NOTES) represents the evolution of surgery towards less invasive procedures. The feasibility of NOTES transrectal approach has increased its clinical applicability. This report describes a first series of minilaparoscopy-assisted...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics