title: Single port access proctectomy with total mesorectal excision and intersphincteric resection with a primary transanal approach.
abstract: OBJECTIVE
  Minimally invasive surgery is advancing with single port access (SPA). We describe a technique for a SPA transabdominal combined with transanal approach to perform laparoscopic proctectomy with total mesorectal excision (TME) and intersphincteric resection of low rectal adenocarcinoma.
  
  
  METHODS
  Transanal intersphincteric resection was followed by laparoscopic abdominal proctectomy with TME. An SPA device was placed at the site of the future stoma through a 2.5-cm incision. A hand-sewn side-to-end coloanal anastomosis was performed and a terminal loop ileostomy was created at the site of the SPA device.
  
  
  RESULTS
  The procedure was performed on two healthy nonobese women who had not had previous abdominal surgery. The operating times were 195 and 210 min, and blood loss < 250 ml. The postoperative course was uneventful, with discharge on postoperative days 5 and 6. Pathological examination revealed adequate surgical margins and lymph node retrieval with an intact mesorectum. Four weeks after stoma closure, the scar in the right lower quadrant was 35 mm in one patient and 45 mm in the other, and the scar from the 5-mm port was barely visible.
  
  
  CONCLUSIONS
  This preliminary experience shows that proctectomy with TME and intersphincteric resection can be safely performed using only two ports.
authors.affiliation: Department of Colorectal Surgery, Beaujon Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), Clichy, France.
authors.forename: S
authors.initials: S
authors.lastname: Gaujoux
authors.forename: F
authors.initials: F
authors.lastname: Bretagnol
authors.forename: J
authors.initials: J
authors.lastname: Au
authors.forename: M
authors.initials: M
authors.lastname: Ferron
authors.forename: Y
authors.initials: Y
authors.lastname: Panis
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery*; D001003:Anal Canal / Q000601:surgery; D016063:Blood Loss, Surgical; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay; D008875:Middle Aged; D057605:Natural Orifice Endoscopic Surgery / Q000379:methods*; D012004:Rectal Neoplasms / Q000601:surgery*; D013997:Time Factors