Transanal Single Port Access to Facilitate Distal Rectal Mobilization: A Step Towards Transanal Colorectal Notes Surgery

Albert M Wolthuis, MD, Andre D’Hoore, MD, PhD

Department of Abdominal Surgery, University Hospital Gasthuisberg Leuven

Introduction
This pilot-study assesses the feasibility of a single port transanal rectal mobilization. Laparoscopic rectal mucosal or intersphincteric sleeve resection is challenging and technically demanding, especially exposure and mobilization of the most distal part of the rectum can be hazardous. The use of a single port access device placed in the muscular anal canal after incision of the sleeve at the appropriate level is proposed to facilitate dissection without sphincter damage. Furthermore, if transanal mobilization of the rectum can be progressed maximally in a cranial way, a complete transanal NOTES rectal resection might become possible.

Patients and methods
All patients treated by a laparoscopic-assisted transal single port rectal mobilization (TAMIS distal rectal mobilization) were included in the study. Incision of the endopelvic fascia and mobilization of the distal rectum and mesorectum was performed via the single port device under direct control. The created pneumo-retroperitoneum further facilitates laparoscopic dissection of the more proximal part.

Results
Ten patients (9 females) with a median age of 55 years had this procedure. Indications were intractable supralevatoric fistula, iatrogenic rectovaginal fistula, Crohn rectitis with tubulovillous adenoma, ulcerative colitis and faecal incontinence. In 6 patients a hand-sewn coloanal anastomosis was made and in the remaining 4 patients a proctectomy was performed. In 3 patients, a pure transanal rectal sleeve resection was performed without laparoscopic assistance. There were no postoperative complications and median hospital stay was 7 days. Pathology showed tubulovillous adenoma in 2 cases. None of the patients reported any anal dysfunction at a median follow-up of 2 months.

Conclusion
The aforementioned procedure is a promising tool in the armamentarium of the colorectal surgeon. It can enable distal rectal mobilization under direct visualisation. The proposed technique could be a step towards transanal colorectal NOTES surgery.


Session: Poster Presentation

Program Number: P096

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