Combined NOTES total mesorectal excision and single-incision laparoscopy principles for conservative proctectomy: a...

Area of Science:

• Colorectal Surgery
• Surgical Oncology
• Minimally Invasive Surgery

Background:

• Standard laparoscopic surgery for low rectal cancer presents challenges.
• Transanal endoscopic total mesorectal excision (TME) is a feasible approach with low conversion rates.
• Combining transanal and single-port abdominal approaches may reduce trauma and improve recovery.

Purpose of the Study:

• To evaluate the short- and mid-term outcomes of a combined transanal endoscopic TME and single-port abdominal surgery technique.
• To assess the feasibility, safety, and efficacy of this novel minimally invasive approach for low rectal cancer.

Main Methods:

• Prospective single-centre study of 41 consecutive patients with low rectal cancer undergoing conservative proctectomy with manual coloanal anastomosis.
• Data collected between January 2012 and April 2015.
• Involved a combined transanal endoscopic TME and single laparoscopic ileostomy-site proctectomy.

Main Results:

• Low conversion rate to open surgery (2.4%).
• Median operating time of 358.5 minutes.
• High rates of complete or nearly complete specimens (100%) with a 4.9% circumferential resection margin positivity.
• Overall survival of 97.5% and disease-free survival of 80.5% at a median follow-up of 29 months.
• Stoma-free survival rate of 95.1%.

Conclusions:

• The combined technique is a promising minimally invasive approach for low rectal cancer.
• It achieves good oncological outcomes and high stoma-free survival.
• This approach offers potential benefits in terms of reduced wound trauma and faster recovery.