Transanal resection using a single port trocar: A new approach to NOTES☆

Abstract Introduction The morbidity and mortality, along with the functional changes that arise from radical surgery of rectal cancer, has led to an increasing interest in local treatment in the early stages of cancer of the rectum. Conventional transanal surgery has a high recurrence rate, for this reason transanal endoscopic microsurgery (TEM) is considered the treatment of choice in the last few years in large rectal adenomas and in early rectal cancer (low risk T1). Patients and method We have intervened five patients, four with a diagnosis of villous adenoma of the rectum, and one in situ rectal carcinoma, using this new transanal approach, with a single port device. Results The locations of the lesions were in the mid-rectum, at a mean distance of 9 cm (range 6–10) from the anal margin. All of them were situated in the posterior side. The resection margins were negative in all cases. The mean size of the adenomas was 4 cm, three being sessile shaped, and one with a short, thick pedicle (>1 cm); the size of the carcinoma was 3 cm. The mean surgical time was 55 minutes. All the patients were discharged 48 hours after the surgical procedure. Conclusion We believe that the transanal endoscopic approach with a single port device is a simple, easily reproducible and cost-effective procedure when compared to TEM.