title: Transanal minimal invasive surgery with the Endorec(TM) trocar: a low cost but effective technique.
abstract: OBJECTIVE
  Transanal endoscopic microsurgery (TEM) is a well-established surgical approach for local excision of benign adenomas and early-stage rectal cancer. This technique is expensive and associated with a long learning curve. To avoid these obstacles, we have developed an alternative approach using the Endorec(TM) trocar (Aspide, France), which combines the advantages of local transanal excision and single-port access. The aim of this study was to evaluate the feasibility of this technique.
  
  
  METHODS
  Fourteen consecutive patients underwent transanal resection using Endorec trocar and standard laparoscopic instruments. A retrospective evaluation of the outcome of this technique was performed.
  
  
  RESULTS
  Fourteen patients were successfully operated. Rectal lesions included adenoma in ten patients, T1 adenocarcinoma in three and one T2 adenocarcinoma not amenable for abdominal surgery. The average distal margin from the anal verge was 10 cm (range 5-17 cm), and the mean diameter was 3.5 cm (range 1-5 cm). Negative margins were obtained in 13 patients (92,8 %). Median operating time was 60 min (range 20-100). The excisional area was sutured in nine patients. Median postoperative stay was 4 days (range 1-13). Postoperative complications (21 %) included postoperative fever in one patient and two patients were readmitted with rectal blood loss 6 and 15 days postoperatively and were treated with conservative measures.
  
  
  CONCLUSIONS
  Our current data show that transanal surgery using Endorec trocar is feasible and safe. Although long-term outcomes and definite indications should be yet evaluated, we believe that this new technique offers a promising alternative to TEM.
authors.affiliation: Department of Digestive Surgery, Rouen University Hospital, 1 rue Germont, 76031, Rouen, Cedex, France.
authors.forename: Valérie
authors.initials: V
authors.lastname: Bridoux
authors.forename: Lilian
authors.initials: L
authors.lastname: Schwarz
authors.forename: Leslie
authors.initials: L
authors.lastname: Suaud
authors.forename: Marie
authors.initials: M
authors.lastname: Dazza
authors.forename: Francis
authors.initials: F
authors.lastname: Michot
authors.forename: Jean-Jacques
authors.initials: JJ
authors.lastname: Tuech
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001003:Anal Canal / Q000473:pathology / Q000601:surgery*; D003365:Costs and Cost Analysis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000191:economics* / Q000379:methods*; D013525:Surgical Instruments / Q000191:economics*