Transanal Removal of Rectal Neuroendocrine Tumor Using Single Port Access

I. Emre Gorgun, MD, Erman Aytac, MD, Feza H Remzi, MD

Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, Ohio

Introduction

Transanal endoscopic surgery using single incision laparoscopic port systems is an emerging technique. Compared to transanal endoscopic microsurgery, this approach can provide better working angles and can be accessible at a fraction of the cost. In this video we present our technique with this approach.

Method and procedure

A fifty years old man with a history of rectal neuroendocrine tumor (NET) was referred to department of colorectal surgery, Cleveland Clinic. His past medical history was significant for asthma, his ASA score was 3 and BMI was 28.8 kg/m2. He underwent 8 months ago colonoscopic removal of a 0.5 cm polyp and was found to have NET on the final pathology. All margins were negative on the specimen with no involvement of the muscularis propria. He was advised to undergo surveillance colonoscopy in 6 months. At this time random cold biopsies from the scar revealed again NET and therefore patient was referred for further management of this area. The scar tissue was located anteriorly at 12 cm from the anal verge. Operation was performed under general anesthesia with the patient positioned in prone jack with split legs. A Gelpoint Path (Applied Medical,Rancho Santa Margarita, CA) transanal single port device was inserted into the anal canal. CO2 was used for insufflation. A full thickness excision with 1.5 cm clear margin around the scar tissue was performed. Dissection was perfomed using monopolar hook cautery. This allowed us to remove 3.5 cm full-thickness rectal wall and part of the mesorectum. Defect on the rectal wall was closed using 2-0 polydioxanone (PDS) sutures in a continuous fashion and was ended using silver bullet.

Results

Operating time was 63 minutes and blood loss was 25 milliliters. Patient was discharged home at the same day after surgery. The final pathology did not reveal any signs of remnant neuorendocrine tumor in the specimen. At 4 weeks follow up patient had excellent continence and flexible sigmoidoscopy revealed complete healing of the resection side.

Conclusion

Transanal removal of rectal neuroendocrine tumors using single port access device is safe and feasible. Single port transanal surgery is a valuable alternative to transanal endoscopic microsurgery.

Session: Video ChannelDay 3

Program Number: V124