Ricardo Zorron, PhD, Henrique Neubarth, MD, Cristine Quintas, MD, Djalma Coelho, PhD, Fabiano B Lemos, MD, Ricardo Vassallo, MD, Manoel Galvao, MD. Department of Surgery — Hospital Municipal Miguel Couto, Department of Surgery — University Hospital Teresópolis HCTCO-FESO, Rio de Janeiro, Brazil
Objectives: Natural orifice surgery has been applied for abdominal surgery in recent years, using either a transvaginal or a transgastric access to perform procedures. Despite potential advantages of using transcolonic NOTES to treat colorectal diseases, its application is still rare in the literature. The study describes new methods in human series of transcolonic NOTES access, using a new oncologic transrectal TME procedure for rectal cancer.
Methods: Surgical resection was indicated for 8 patients with diagnosed rectal adenocarcinoma at middle third of the rectum, and 3 patients with benign tumors. IRB approval was obtained at the institution for the study, and the patients signed informed consent. Total mesorectal resection and rectosigmoidectomy was performed using single port device directly inserted in the rectum, and dissection was progressed proximally using intracolonic LESS dissection. Laparoscopic assistance was used for IMA ligation and left colon mobilization. Specimens were extracted transanally, and stappled or sutured transorificial anastomosis was performed.
Results: 8 patients were submitted to Transcolonic NOTES and TME, and 3 to transrectal single port TEM. Operative time was a mean of 290 min, and minor complications were recorded. One patient was converted to laparoscopic surgery and one to open surgery. The postoperative course at 15 days was uneventful, with resumption of oral diet on the second or third postoperative day. Pain scores were low for this initial casuistic. Adequate lymphnode count and free margins were obtained.
Conclusion: NOTES access for colorectal surgery is a promising new approach besides existing laparoscopic and open surgery to improve patient care. Transcolonic NOTES using transrectal single port devices is feasible and can be performed with available technology.
Program Number: S025