Transanal colorectal resection using natural orifice translumenal endoscopic surgery (NOTES)

Area of Science:

• Colorectal Surgery
• Minimally Invasive Surgery
• Surgical Oncology

Background:

• Total mesorectal excision (TME) is the standard for rectal cancer surgery.
• Open TME has significant morbidity, driving interest in minimally invasive approaches.
• Natural orifice translumenal endoscopic surgery (NOTES) offers potential for 'incisionless' procedures.

Purpose of the Study:

• To evaluate the feasibility and safety of transanal TME with laparoscopic assistance.
• To compare outcomes of transanal TME with laparoscopic TME.
• To assess the oncological safety and survival rates of this novel technique.

Main Methods:

• Retrospective analysis of early clinical series (n=72) of transanal TME with laparoscopic assistance.
• Evaluation of intraoperative and postoperative complication rates.
• Assessment of specimen integrity, margin status, recurrence rates, and survival data.

Main Results:

• Overall complication rates were 8.3% (intraoperative) and 27.8% (postoperative), similar to laparoscopic TME.
• Mesorectal specimens were intact in all patients with 94.4% negative margins.
• No oncological recurrence in average-risk patients; comparable 2-year survival in high-risk patients.

Conclusions:

• Transanal NOTES TME with laparoscopic assistance is clinically feasible and safe with careful patient selection and expertise.
• This technique shows promising short-term oncological outcomes.
• Further optimization of transanal instruments and techniques may lead to pure transanal NOTES TME as a viable alternative.