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Transanal Endoscopic Surgery Using Different Single-Port Devices.

Cornelia Lorenz1, Thomas Nimmesgern1, Thomas E Langwieler2

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Transanal single-port access surgery offers a modified approach for rectal cancer and polyp excision. This technique demonstrates feasibility, reduced discomfort, and lower risk of anal sphincter damage compared to traditional methods.

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Area of Science:

  • Colorectal Surgery
  • Minimally Invasive Surgery
  • Surgical Oncology

Background:

  • Transanal endoscopic microsurgery (TEM) is established for rectal lesions.
  • Single Port Access (SPA) surgery, successful in laparoscopy, presents an opportunity for advancement.
  • There is a need for improved transanal techniques for low-risk rectal cancers and polyps.

Purpose of the Study:

  • To provide an overview of technical options for transanal single-port access (SPA) surgery.
  • To present experiences with different SPA devices in modified transanal endoscopic microsurgery (TEM).
  • To evaluate the feasibility and outcomes of SPA modified TEM for selected rectal lesions.

Main Methods:

  • SPA modified TEM was performed on thirteen patients with low-risk rectal cancers or polyps with dysplasia.
  • Procedures utilized SILS™ Port, TriPort®, or TriPort+® devices with laparoscopic instruments.
  • Transanal placement of devices was assessed for ease of performance, with no prior anal sphincter dilatation required.

Main Results:

  • All transanal single-port procedures were completed successfully without major complications.
  • Device placement was straightforward, and excellent visualization allowed for accurate dissection.
  • Postoperative follow-up revealed unremarkable examinations, indicating successful outcomes.

Conclusions:

  • Transanal single-port surgery is a feasible and effective modification of TEM.
  • The technique offers benefits including comfortable feasibility, reduced postoperative discomfort, and a lower risk of anal sphincter damage.
  • SPA modified TEM is a viable alternative for selected low-risk rectal cancers and broad-based polyps.