Thanks to endoscopic assistance and the pressure effect of pelvic pneumoperitoneum, transanal total mesorectal excision (taTME) can better expose the surgical field of distal mesorectal space, and may have a prospect for the preservation of pelvic nerves and organ function. The transanal minimally invasive surgery (TAMIS) platform may decrease the injury of internal anal sphincter and protect anal function. Current data show that taTME procedure has similar results on postoperative anal function, urinary function and sexual function compared to transabdominal TME procedure. The early impaired anal function after taTME may be related to the transanal approach itself, implement of single port and the learning curve, but the anal function can improve with time. Regarding the protection of urinary and sexual function, the beginners should be familiar with the course of pelvic nerves, the anatomical landmarks and the technical points during the dissection upward, and try to avoid the injury of the pelvic plex trunk and pelvic splanchnic nerves. TaTME is different from natural orifice transluminal endoscopic surgery (NOTES), while the latter focuses on the minimally invasive principle, the former focuses on the oncological safety and nerve protection. We should combine the advantages of transanal and transabdominal approaches to achieve the final goal of surgical quality improvement and organ function preservation.
Humans ; Learning Curve ; Natural Orifice Endoscopic Surgery ; Rectal Neoplasms ; Rectum ; surgery ; Transanal Endoscopic Surgery

The surgical treatment of low rectal diseases has gradually changed from open radical operation to endoscopic minimally invasive operation. Transanal total mesorectal excision (taTME) combines endoscopic technique with transanal approach, and solves the problem of surgery exposure in lower rectal cancer. It has become an option for colorectal surgeons in lower rectal cancer. We named this operation as transanal endoscopic surgery, for the appropriateness when it is applied for other colorectal diseases. Transanal endoscopic surgery belongs to the category of natural orifice transluminal endoscopic surgery, which achieves the same pathological outcomes with less invasiveness and better organ functions compared with traditional surgery. It represents the tendency of low rectal surgery.
Digestive System Surgical Procedures ; Humans ; Minimally Invasive Surgical Procedures ; Natural Orifice Endoscopic Surgery ; Rectal Neoplasms ; Transanal Endoscopic Surgery

Humans ; Natural Orifice Endoscopic Surgery

Minimally invasive surgery and laparoscopic surgery have been used for more than 30 years, and are now popular even for some malignant diseases. There have been two developments in technology; one is robotic surgery and the other is less minimally invasive surgery like natural orifice transluminal endoscopic surgery (NOTES) and single port laparoscopic surgery. NOTES, using the current platform of a conventional fiberscope and side channel instruments for surgery, suffers many limitations, including image quality, flexibility of the fiberscope, size of the side channel, and difficulty of closing the opening. Due to the above-mentioned limitations, single port laparoscopic surgery has many advantages over. This review aims to define single port laparoscopic surgery and describe its terminology and technology. To perform single port laparoscopic surgery efficiently, new instruments (e.g., a laparoscopic camera, ports, laparoscopic instruments) and combining other innovative methods into surgery are both helpful. Even though there have been many developments in laparoscopic cameras, ports, and laparoscopic instruments to enhance single port laparoscopic surgery, further improvements are needed. Motorized instruments or using a robotic platform in combination with single port laparoscopic surgery will be another way to overcome the limitations of current single port laparoscopic surgery. Single port laparoscopic surgery is a technique that has recently emerged, but will be performed in a wider range of surgical procedures based on developments in laparoscopic cameras, ports and laparoscopic instrument technology.
Laparoscopy ; Natural Orifice Endoscopic Surgery ; Pliability

Humans ; Natural Orifice Endoscopic Surgery ; methods ; trends

PURPOSE: To evaluate the feasibility of transanal total mesorectal excision (TME) in patients with rectal cancer. METHODS: This study enrolled 12 patients with clinically node negative rectal cancer located 4–12 cm from the anal verge who underwent transanal endoscopic TME with the assistance of single port laparoscopic surgery between September 2013 and August 2014. The primary endpoint was TME quality; secondary endpoints included number of harvested lymph nodes and postoperative complications within 30 days (NCT01938027). RESULTS: The 12 patients included 7 males and 5 females, of median age 59 years and median body mass index 24.2 kg/m². Tumors were located on average 6.7 cm from the anal verge. Four patients (33.3%) received preoperative chemoradiotherapy. Median operating time was 195 minutes and median blood loss was 50 mL. There were no intraoperative complications and no conversions to open surgery. TME was complete or nearly complete in 11 patients (91.7%). Median distal resection and circumferential resection margins were 18.5 mm and 10 mm, respectively. Median number of harvested lymph nodes was 15. Median length of hospital stay was 9 days. There were no postoperative deaths. Six patients experienced minor postoperative complications, including urinary dysfunction in 2, transient ileus in 3, and wound abscess in 1. CONCLUSION: This pilot study showed that high-quality TME was possible in most patients without serious complications. Transanal TME for patients with rectal cancer may be feasible and safe, but further investigations are necessary to evaluate its long-term functional and oncologic outcomes and to clarify its indications.
Abscess ; Body Mass Index ; Chemoradiotherapy ; Female ; Humans ; Ileus ; Intraoperative Complications ; Laparoscopy ; Length of Stay ; Lymph Nodes ; Male ; Minimally Invasive Surgical Procedures ; Natural Orifice Endoscopic Surgery ; Pilot Projects* ; Postoperative Complications ; Rectal Neoplasms* ; Transanal Endoscopic Surgery ; Wounds and Injuries

The research on natural orifice transluminal endoscopic surgery (NOTES) and laparoscopic single-site surgery (LESS) are current worldwide focuses international areas of minimally invasive surgery. NOTES needs further investigation, and as the most available of no scar techniques, LESS provides a transition. Currently, both laparoscopy-assisted NOTES colorectal resection and totally NOTES colorectal resection have been reported, however, the techniques are still mainly under animal investigation. Multiple LESS colorectal resections have been reported worldwide, and the feasibility has been proved by those reports. What's more, whether LESS colorectal resection can fulfil the requirements of radical tumor resection needs further investigation.
Colorectal Surgery ; Humans ; Laparoscopy ; methods ; Natural Orifice Endoscopic Surgery ; methods

BACKGROUNDThe infection risk of natural orifice transluminal endoscopic surgery (NOTES) is of concern. The aim of this study was to assess the safety of NOTES by investigating the intraperitoneal bacterial load during transgastric and transvaginal procedures with antiseptic or controlling perioperative preparation.

METHODSForty-five female pigs were randomly assigned to five equal groups: the transgastric (TG) control group (group A), the TG middle volume gastric lavage group (group B), the TG high volume lavage group (group C), the transvaginal (TV) control group (group D) and the TV study group (group E). The study groups received gastric or vaginal lavage and abdominal antimicrobial irrigation, while the control groups received neither. All animals were administered intravenous antibiotics, underwent NOTES peritoneoscopy and transumbilical laparoscopic cholecystectomy under NOTES view with sterile instruments. The viscerotomy was closed by laparoscopic suture. The animals were observed until necropsy was performed 14 days postoperatively. Quantitative bacteriologic cultures were taken from the gastric or vaginal aspirate before and after lavage; peritoneal fluid was collected before and after peritoneal irrigation and at necropsy.

RESULTSThe surgical procedures were completed for all the pigs and all of them survived. The mean operative time of the TG group and the TV group was (81 ± 27) minutes and (66 ± 12) minutes, respectively. All animals survived for 14 days. At necropsy, significantly more peritoneal infections were noted in group A than in group D (5:9 vs. 0:9; P < 0.05). No gross evidence of intra-peritoneal infection was found in groups B, C, D and E. Bacteriological evidence was seen in all pigs in group A, 7 pigs in group B, 6 pigs in group D, and none in groups C and E.

CONCLUSIONSWithout gastric or vaginal lavage and antibiotic peritoneal irrigation, the TG procedure has a higher infection rate than the TV access. After antiseptic preparation, the bacterial load significantly decreased in the TG group, which seems as safe as the sterile TV approach.

Two female patients with rectal tumor undergoing proctectomy via vagina, namely natural orifice transluminal endoscopic surgery (NOTES), are reported. The operations were performed on June 8 and August 10, 2010, respectively. No Trocar was used in the abdomen except for the transumbilical incision. There were no visible scars in the abdomen. Tubulovillous adenoma and moderately differentiated adenocarcinoma were diagnosed respectively through postoperative pathological examination. Both patients resumed normal work and life at the most recent follow up. Sexual life was satisfactory.
Adult ; Female ; Humans ; Natural Orifice Endoscopic Surgery ; methods ; Rectal Neoplasms ; surgery ; Vagina ; surgery

Endoscopy ; Humans ; Natural Orifice Endoscopic Surgery ; methods ; Nose ; Pituitary Neoplasms ; surgery ; Quality of Life ; Sphenoid Sinus