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Natural Orifice Approaches in Rectal Surgery: Transanal Endoscopic Proctectomy

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Techniques in Minimally Invasive Rectal Surgery

Abstract

The concept of natural orifice translumenal endoscopic surgery (NOTES) was seamlessly adapted to colorectal resections, enabled by the availability of a wide array of transanal endoscopic platforms. Since the demonstration of the feasibility of this approach in experimental models and human cadavers, transanal endoscopic proctectomy has rapidly emerged as one of the most exciting new trends in rectal cancer surgery. Indications for this approach range from benign inflammatory conditions to malignant disease of the rectum, particularly of the mid- and low rectum, where transanal endoscopic access can be applied to completion proctectomy, total proctocolectomy, abdominoperineal resection (APR), restorative proctectomy or proctocolectomy with ileoanal J pouch reconstruction, and low anterior resection with total mesorectal excision (TME). Whether it is performed using a pure or hybrid approach, transanal endoscopic proctectomy has the potential to reduce the technical complexity, morbidity, and operative time associated with open and laparoscopic proctectomy. Preliminary outcomes from 16 published series on this approach for benign and malignant pathology suggest that this approach is safe in carefully selected patients. Specific indications, preoperative work-up, surgical techniques, and expected complications associated with transanal endoscopic proctectomy, as well as tips and tricks for success, will be reviewed, based on the rapidly expanding literature on this approach.

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Abbreviations

APR:

Abdominoperineal resection

BMI:

Body mass index

CD:

Crohn’s disease

CRM:

Circumferential resection margin

DRE:

Digital rectal examination

IBD:

Inflammatory bowel disease

IPAA:

Ileoanal pouch anastomosis

ISR:

Intersphincteric resection

LAR:

Low anterior resection

NOTES:

Natural Orifice Endoscopic Surgery

TAMIS:

Transanal minimally invasive surgery

taTME:

Transanal endoscopic total mesorectal excision

TME:

Total mesenteric excision

UC:

Ulcerative colitis

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Author information

Authors and Affiliations

  1. Department of Surgery, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA

    Uma M. Sachdeva M.D., Ph.D.

  2. Division of Colorectal Surgery, Department of Surgery, Mount Sinai Hospital, Icahn School of Medicine, Massachusetts General Hospital, 5 East 98th Street Box 1259, New York, NY, 10029, USA

    Patricia Sylla M.D., F.A.C.S., F.A.S.C.R.S.

Authors
  1. Uma M. Sachdeva M.D., Ph.D.
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  2. Patricia Sylla M.D., F.A.C.S., F.A.S.C.R.S.
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Correspondence to Patricia Sylla M.D., F.A.C.S., F.A.S.C.R.S. .

Editor information

Editors and Affiliations

  1. Division of Colon and Rectal Surgery, University of California, Irvine, Orange, CA, USA

    Alessio Pigazzi

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Sachdeva, U.M., Sylla, P. (2018). Natural Orifice Approaches in Rectal Surgery: Transanal Endoscopic Proctectomy. In: Pigazzi, A. (eds) Techniques in Minimally Invasive Rectal Surgery. Springer, Cham. https://doi.org/10.1007/978-3-319-16381-9_11

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  • DOI: https://doi.org/10.1007/978-3-319-16381-9_11

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-16380-2

  • Online ISBN: 978-3-319-16381-9

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