title: Dynamic article: transanal rectal excision: a pilot study.
abstract: BACKGROUND
  Laparoscopic total mesorectal excision can be difficult in a narrow pelvis. Transanal minimally invasive surgery allows the surgeon to mobilize the most distal part of the rectum by using a single port positioned in the anal canal.
  
  
  OBJECTIVE
  We aim to assess the safety and feasibility of transanal rectal excision.
  
  
  METHODS
  This pilot study was conducted in a university hospital and tertiary colorectal referral center in Belgium.
  
  
  METHODS
  Over a 12-month period, all consecutive patients with benign disease and ASA grade 3 patients with a rectal carcinoma who required either intersphincteric proctectomy or coloanal anastomosis were included.
  
  
  METHODS
  After intersphincteric dissection or sleeve mucosectomy, a single-access multichannel port was inserted into the anal canal. A transanal rectal excision was performed by using conventional laparoscopic instruments. The planes were developed as cephalad as possible, until the pouch of Douglas was opened. A laparoscopically assisted approach was used to gain bowel length and was used in patients who required proctectomy. In the case of a reconstruction, a handsewn coloanal anastomosis was made.
  
  
  METHODS
  Intraoperative challenges, conversion rate, operating time, blood loss, morbidity, and length of stay were assessed.
  
  
  RESULTS
  Fourteen patients underwent a transanal rectal excision for both benign (9) and malignant (5) disease. In 11 patients (79%), laparoscopically assisted transanal minimally invasive rectal excision was performed. The median (range) transanal operating time was 55 (35-95) minutes. Intraoperative difficulties hindering dissection occurred in 5 patients and were due to inadequate exposure, rectal perforation, or fibrosis secondary to radiotherapy for prostate cancer. There was minimal postoperative morbidity, with a median follow-up of 6.3 (1.5-13.8) months. All patients were discharged within 14 days postoperatively, and there were no readmissions.
  
  
  CONCLUSIONS
  The study was limited by the small number of patients.
  
  
  CONCLUSIONS
  Transanal rectal excision is safe and feasible and could be a promising technique to facilitate distal rectal mobilization (see Video, Supplemental Digital Content 1, http://links.lww.com/DCR/A125).
authors: Department of Abdominal Surgery, University Hospital Leuven, Leuven, Belgium.
authors: Albert M
authors: AM
authors: Wolthuis
authors: Anthony
authors: A
authors: de Buck van Overstraeten
authors: André
authors: A
authors: D'Hoore
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001003:Anal Canal / Q000601:surgery*; D000714:Anastomosis, Surgical; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D003106:Colon / Q000601:surgery; D061887:Conversion to Open Surgery / Q000706:statistics & numerical data; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy / Q000295:instrumentation; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000295:instrumentation / Q000379:methods*; D061646:Operative Time; D010865:Pilot Projects; D011183:Postoperative Complications; D012002:Rectal Diseases / Q000601:surgery*; D012007:Rectum / Q000601:surgery*; D016896:Treatment Outcome