Hybrid NOTES: TEO for transanal total mesorectal excision: intracorporeal resection and anastomosis



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.

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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.

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Serra-Aracil, X., Mora-López, L., Casalots, A. et al. Hybrid NOTES: TEO for transanal total mesorectal excision: intracorporeal resection and anastomosis. Surg Endosc 30, 346–354 (2016). https://doi.org/10.1007/s00464-015-4170-5

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  • Transanal excision
  • Transanal TME
  • TEO
  • TEM
  • Hybrid NOTES