title: Transanal endoscopic surgery using a single access port: a practical tool in the surgeon's toybox.
abstract: BACKGROUND
  Large polyps and early carcinomas of the rectum may be excised with transanal endoscopic surgery (TES). Single-port techniques are emerging in the field of colorectal surgery and have been adapted to many colorectal procedures so far. In this article, we aimed to present our initial experience with TES using a single access port with its technical details.
  
  
  METHODS
  Patients undergoing TES using a single access port between July 2010 and January 2013 were included in the study. Patient demographics, operative technique, and both operative and postoperative outcomes were evaluated and presented.
  
  
  RESULTS
  A total of 12 patients (ten males) were included in our study. The median age was 63.5 years (50-84), median American Society of Anesthesiologists (ASA) score was 3 (2-4), and median body mass index was 28.8 kg/m(2) (17.4-55.6). Median operating time was 79 min (43-261). Histopathological diagnoses were as follows: tubulovillous adenoma (n = 6), tubular adenoma (n = 4), adenocarcinoma (n = 1), and neuroendocrine tumor (n = 1). Five patients were sent home on the day of surgery and the median postoperative hospital stay was 1 day (0-38). Median estimated blood loss was 22.5 ml (5-150). A transient urinary retention was developed in one patient postoperatively, and two patients had postoperative bleeding. The first of these patients with a long history of anticoagulant usage had rectal bleeding 13 days after surgery, which was successfully managed with medical treatment. The second patient was morbidly obese, had multiple comorbidities, and had rectal bleeding on postoperative day 7 which was managed with local epinephrine injection. He suffered unrelated cardiac death on postoperative day 38.
  
  
  CONCLUSIONS
  TES is safe and feasible when using a single port and in the standard laparoscopic setting. The single-port technique may play a major role in the widespread utilization of TES as a treatment for large adenomas and early rectal cancers.
authors.forename: I E
authors.initials: IE
authors.lastname: Gorgun
authors.affiliation: Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA, gorgune@ccf.org.
authors.forename: I Emre
authors.initials: IE
authors.lastname: Gorgun
authors.forename: Erman
authors.initials: E
authors.lastname: Aytac
authors.forename: Meagan M
authors.initials: MM
authors.lastname: Costedio
authors.forename: Hasan H
authors.initials: HH
authors.lastname: Erem
authors.forename: Michael A
authors.initials: MA
authors.lastname: Valente
authors.forename: Luca
authors.initials: L
authors.lastname: Stocchi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003111:Colonic Polyps / Q000000981:diagnostic imaging / Q000601:surgery*; D019160:Endosonography; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D020706:Laparoscopes; D010535:Laparoscopy / Q000295:instrumentation*; D008297:Male; D008875:Middle Aged; D057605:Natural Orifice Endoscopic Surgery / Q000295:instrumentation*; D009666:Nose; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome