Hybrid NOTES: TEO for transanal total mesorectal excision: intracorporeal resection and anastomosis
- 511 Downloads
Laparoscopic surgery for rectal TME achieves better patient recovery, lower morbidity, and shorter hospital stay than open surgery. However, in laparoscopic rectal surgery, the overall conversion rate is nearly 20 %. Transanal TME combined with laparoscopy, known as Hybrid NOTES, is a less invasive procedure that provides adequate solutions to some of the limitations of rectal laparoscopy. Transanal TME via TEO with technical variants (intracorporeal resection and anastomosis, TEO review of the anastomosis) attempts to standardize and simplify the procedure.
Prospective observational study was used describe and assess the technique in terms of conversion to open surgery, overall morbidity, surgical site infection and hospital stay. The sample comprised consecutive patients diagnosed with rectal tumor less than 10 cm from the anal verge who were candidates for low anterior resection using TME (except T4). Demographic, surgical, postoperative, and pathological variables were analyzed, as well as morbidity rates.
From September 2012 to August 2014, 32 patients were included. The conversion rate was 0 %. Overall morbidity was 31.3 %, SSI rate was 9.4 %, and mean hospital stay was 8 days. Oncological radical criteria were achieved with pathological parameters of 94 % of complete TME and a median circumferential margin of 13 mm.
The introduction of technical variants of TEO for transanal resection can facilitate a procedure that requires extensive experience in transanal and laparoscopic surgery. Studies of sphincter function, quality of life, and long-term oncological outcome are now necessary.
KeywordsTransanal excision Transanal TME TEO TEM NOTES Hybrid NOTES
We thank the members of the multidisciplinary committee for colorectal tumors at the Parc Taulí University Hospital; we thank Mrs. Cristina Gomez Vigo for correcting the manuscript and Michael Maudsley for help with the English.
Xavier Serra-Aracil, Laura Mora-López, Alex Casalots, Carles Pericay, Raul Guerrero, Salvador Navarro-Soto have no conflicts of interest or financial ties to disclose.
Supplementary material 1 (MOV 75076 kb)
Supplementary material 2 (MOV 57259 kb)
Supplementary material 3 (MOV 77548 kb)
Supplementary material 4 (MOV 75337 kb)
- 2.Van der Pas MH, Haglind E, Cuesta MA, Fürst A, Lacy AM, Hop WC, Bonjer HJ; COlorectal cancer Laparoscopic or Open Resection II (COLOR II) Study Group (2013) Laparoscopic versus open surgery for rectal cancer (COLOR II): short-term outcomes of a randomised, phase 3 trial. Lancet Oncol 14:210–218Google Scholar
- 4.Serra Aracil X, Mora-Lopez L, Alcantara-Moral M, Corredera-Cantarín C, Gomez-Diaz C, Navarro-Soto S (2014). Atypical Indication for transanal endoscopic microsurgery to avoid major surgery. Tech Coloproctol 18(2):157–164Google Scholar
- 6.Buess GF, Misra MC, Bhattacharjee HK, Becerra Garcia FC, Bansal VK, Bermudez JR (2011) Single-port surgery and NOTES: from transanal endoscopic microsurgery and transvaginal laparoscopic cholecystectomy to transanal rectosigmoid resection. Surg Laparosc Endosc Percutan Tech 21:e110–e119PubMedCrossRefGoogle Scholar
- 7.Rattner D, Kalloo A, ASGE/SAGES Working Group (2006) ASGE/SAGES working group on natural orifice translumenal endoscopic surgery. Surg Endosc 20:329–333Google Scholar
- 8.Lehmann KS, Ritz JP, Wibmer A, Gellert K, Zornig C, Burghardt J, Büsing M, Runkel N, Kohlhaw K, Albrecht R, Kirchner TG, Arlt G, Mall JW, Butters M, Bulian DR, Bretschneider J, Holmer C, Buhr HJ (2010) The German registry for natural orifice translumenal endoscopic surgery: report of the first 551 patients. Ann Surg 252:263–270PubMedCrossRefGoogle Scholar
- 14.Horgan S, Cullen JP, Talamini MA, Mintz Y, Ferreres A, Jacobsen GR, Sandler B, Bosia J, Savides T, Easter DW, Savu MK, Ramamoorthy SL, Whitcomb E, Agarwal S, Lukacz E, Dominguez G, Ferraina P (2009) Natural orifice surgery: initial clinical experience. Surg Endosc 23:1512–1518PubMedPubMedCentralCrossRefGoogle Scholar
- 16.Lacy AM, Rattner DW, Adelsdorfer C, Tasende MM, Fernández M, Delgado S, Sylla P, Martínez-Palli G (2013) Transanal natural orifice transluminal endoscopic surgery (NOTES) rectal resection: “down-to-up” total mesorectal excision (TME)-short-term outcomes in the first 20 cases. Surg Endosc 27:3165–3172PubMedCrossRefGoogle Scholar
- 17.Velthuis S, Nieuwenhuis DH, Ruijter TE, Cuesta MA, Bonjer HJ, Sietses C (2014) Transanal versus traditional laparoscopic total mesorectal excision for rectal carcinoma. Surg Endosc. PMID: 24972923 (Epub ahead of print)Google Scholar
- 18.National Comprehensive Cancer Network. Rectal Cancer. Clinical Practice Guidelines in Oncology: National Comprehensive. Cancer Network; version 3, 2014; http://www.nccn.org. Accessed 15 Aug 2014
- 19.Serra Aracil X, Bombardó Junca J, Mora López L, Alcántara Moral M, Ayguavives Garnica I, Navarro Soto S (2006) Transanal endoscopic microsurgery (TEM). Current situation and future expectations. Cir Esp 80:123–132Google Scholar
- 26.Tekkis PP, Prytherch DR, Kocher HM, Senapati A, Poloniecki JD, Stamatakis JD, Windsor AC (2004) Development of a dedicated risk adjustment scoring system for colorectal surgery (colorectal POSSUM). Br J Surg 91:1174–1182Google Scholar
- 27.Rahbari NN, Weitz J, Hohenberger W, Heald RJ, Moran B, Ulrich A, Holm T, Wong WD, Tiret E, Moriya Y, Laurberg S, den Dulk M, van de Velde C, Büchler MW (2010) Definition and grading of anastomotic leakage following anterior resection of the rectum: a proposal by the International Study Group of Rectal Cancer. Surgery. 147:339–351PubMedCrossRefGoogle Scholar
- 29.Serra-Aracil X, Mora-Lopez L, Alcantara-Moral M, Caro-Tarrago A, Navarro-Soto S (2014) Transanal endoscopic microsurgery with 3-D (TEM) or high-definition 2-D transanal endoscopic operation (TEO) for rectal tumors. A prospective, randomized clinical trial. Int J Colorectal Dis 29:605–610PubMedCrossRefGoogle Scholar
- 33.Fernández-Hevia M, Delgado S, Castells A, Tasende M, Momblan D, Díaz Del Gobbo G, DeLacy B, Balust J, Lacy AM (2014) Transanal total mesorectal excision in rectal cancer: short-term outcomes in comparison with laparoscopic surgery. Ann Surg. PMID: 25185463 (Epub ahead of print)Google Scholar