I. Emre Gorgun, MD, Erman Aytac, MD, Meagan M Costedio, MD, Hasan H Erem, MD, Luca Stocchi, MD
Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, Ohio
Introduction
Transanal endoscopic microsurgery (TEM) is one of the early applications of NOTES for excising large polyps and T1 carcinomas of the rectum. However TEM can be relatively expensive and technically complex as well as challenging for most surgeons. By using single incision laparoscopic port systems, surgeons can simply remove rectal tumors transanally. In this report, we present our experience and early results with this technique.
Patients and methods
Patients undergoing single port transanal endoscopic surgery between July 2010 and September 2012 were included in the study. Patient demographics, operative technique, operative and postoperative outcomes were evaluated and presented.
Results
There were nine patients (seven males). Median age of the patients was 66 (53-84); median ASA score was 3 (2-4); median BMI was 28.7 kg/m2 (17.4-55.6). Median operating time was 82 minutes (43-261). Patient characteristics and tumor details are summarized in the table. Final tumor histopathology were as follows: tubulovillous adenoma (n=4), tubular adenoma (n=3), adenocarcinoma (n=1), neuroendocrine tumor (n=1). Four patients were sent home same day after surgery; median postoperative hospital stay was 1 day (0-38). Median estimated blood loss was 25 ml (5-75). A transient urinary retention developed in one patient. There were two patients who had postoperative bleeding. First patient who was on chronic anticoagulation had rectal bleeding 13 days after surgery which was successfully managed with medical treatment non-operatively. Second patient who was morbidly obese and had multiple comorbid conditions had rectal bleeding on postoperative day seven managed with local epinephrine injection. He suffered sudden cardiac death, which was unrelated with the surgical complication on postoperative day 38.
Conclusions
Transanal endoscopic surgery is safe and feasible by using single port and standard laparoscopic setting. Future studies will need to assess potential benefits when compared to traditional TEM.
| Patients | Age | ASA | Gender |
Tumor Diameter (cm) |
Distance from AV (cm) |
Co-morbidity |
| 1 | 58 | 2 | Male | 3.5 | 6 | None |
| 2 | 84 | 4 | Female | 4 | 8 | DM, CAD, HTN |
| 3 | 66 | 3 | Female | 2 | 8 | HL |
| 4 | 53 | 3 | Male | 2.5 | 10 | HTN, CMP |
| 5 | 62 | 3 | Male | 1 | 9 | HTN, HL, Hx of GI Bleed |
| 6 | 69 | 3 | Male | 3 | 10 | AAA, HTN, HL |
| 7 | 76 | 3 | Male | 4 | 6 | DM, Morbid Obesity, CAD, MI |
| 8 | 70 | 4 | Male | 4 | 9 | HTN, Hx of Esophageal Ca |
| 9 | 50 | 3 | Male | 0.5 | 12 | Asthma |
AAA: Abdominal aortic aneurism, ASA: American Society of Anesthesiologists, AV: Anal verge, Ca: Cancer, CAD: Coronary artery disease, CMP: Cardiomyopathy, DM: Diabetes mellitus, GI: Gastrointestinal, HL: Hyperlipidemia, HTN: Hypertension, MI: Myocardial infarction
Session: Poster Presentation
Program Number: P130
