Perirectal NOTES access: "down-to-up" total mesorectal excision for rectal cancer
Related Experiment Video
Updated: May 31, 2026
Robot-assisted Total Mesorectal Excision and Lateral Pelvic Lymph Node Dissection for Locally Advanced Middle-low Rectal Cancer
Published on: February 12, 2022
Ricardo Zorron1, Henrique Neubarth Phillips, Djalma Coelho
1University Hospital Teresopolis HCTCO FESO, Rio de Janeiro, Brazil. rzorron@terra.com.br
Objectives:
Clinical natural orifice surgery has been applied for abdominal surgery in recent years, mostly by vaginal and oral access. The study describes preliminary successful human applications of transcolonic natural orifice transluminal endoscopic surgery (NOTES), using a new transrectal total mesorectal excision procedure for rectal cancer.
Methods:
Institutional review board approval was obtained for the study. In 2 patients with rectal adenocarcinoma, total mesorectal resection and rectosigmoidectomy with lymphadenectomy was performed using a low NOTES transcolonic access. "Down-to-up" mesorectal dissection was achieved either using a flexible scope or a transrectal single port device. The specimens were extracted transanally, and transorificial low anastomosis was performed.
Results:
Operative time was 350 and 360 minutes, respectively; no complications occurred and patients were discharged after 6 days.
Conclusion:
Successful human reports on transcolonic NOTES suggest potential applications. The treatment of colorectal diseases through transorificial single port or flexible perirectal NOTES access are promising new approaches besides current methods to improve patient care.
