title: Transanal colorectal resection using natural orifice translumenal endoscopic surgery (NOTES).
abstract: The surgical management of rectal cancer has evolved over the past century, with total mesorectal excision (TME) emerging as standard of care. As a result of the morbidity associated with open TME, minimally invasive techniques have become popular. Natural orifice translumenal endoscopic surgery (NOTES) has been held as the next revolution in surgical techniques, offering the possibility of 'incisionless' TME. Early clinical series of transanal TME with laparoscopic assistance (n = 72) are promising, with overall intraoperative and postoperative complication rates of 8.3% and 27.8%, respectively, similar to laparoscopic TME. The mesorectal specimen was intact in all patients, and 94.4% had negative margins. There was no oncological recurrence in average-risk patients at short-term follow up, and 2-year survival rates in high-risk patients were comparable to that after laparoscopic TME. These preliminary studies demonstrate transanal NOTES TME with laparoscopic assistance to be clinically feasible and safe given careful patient selection, surgical expertise, and appropriate procedural training. We are hopeful that with optimization of transanal instruments and surgical techniques, pure transanal NOTES TME will become a viable alternative to open and laparoscopic TME in the future.
authors.affiliation: Department of Surgery, Division of Gastrointestinal Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA.
authors.forename: Isha Ann
authors.initials: IA
authors.lastname: Emhoff
authors.forename: Grace Clara
authors.initials: GC
authors.lastname: Lee
authors.forename: Patricia
authors.initials: P
authors.lastname: Sylla
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery*; D001003:Anal Canal; D002986:Clinical Trials as Topic; D006801:Humans; D057605:Natural Orifice Endoscopic Surgery / Q000379:methods*; D018579:Patient Selection; D012004:Rectal Neoplasms / Q000601:surgery*
keywords: minimally invasive surgery; natural orifice translumenal endoscopic surgery (NOTES); rectal cancer; total mesorectal excision; transanal