title: Evaluation of three types of platforms in single-incision laparoscopic surgery for performing transanal endoscopic microsurgery (SILSTEM).
abstract: OBJECTIVE
  Transanal endoscopic microsurgery using a platform for single-incision laparoscopic surgery (SILSTEM) is safe for excising rectal lesions. We tested three types of platforms.
  
  
  METHODS
  Nine patients underwent SILSTEM by one surgeon. Tumors located 5–15 cm from the anal verge were eligible. After measuring their dimensions, length, and trocar channels, the platforms tested were the SILSTM port (SP), EZTM access (EA), and GelPOINTTM Path (GP). Clinicopathology, intraoperative parameters, and postoperative outcomes were recorded.
  
  
  RESULTS
  Six men and three women (median age 63 years) underwent SILSTEM using platform SP in three patients, EA in four, GP in two. Median operation time was 128 min (range 71–313). Median blood loss was 3 ml (range 1–71). Pathology confirmed adenocarcinoma in five patients, adenoma in three, and carcinoid in one. Patients were discharged within 2–13 days postoperatively. There was no postoperative fecal incontinence or soiling. Overall median follow-up was 13.3 months (range 1.3–27.2). There were no recurrences.
  
  
  CONCLUSIONS
  SILSTEM can effectively resect rectal tumors using any of three platforms. Large prospective trials are needed to define the advantages, disadvantages, and indications for each platform and to draw conclusions regarding operation time, anorectal function, and costs.
authors.forename: Shigeoki
authors.initials: S
authors.lastname: Hayashi
authors.forename: Tadatoshi
authors.initials: T
authors.lastname: Takayama
authors.forename: Minoru
authors.initials: M
authors.lastname: Matsuda
authors.forename: Masahito
authors.initials: M
authors.lastname: Ikarashi
authors.forename: Ken
authors.initials: K
authors.lastname: Hagiwara
authors.forename: Takeki
authors.initials: T
authors.lastname: Suzuki
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery*; D000236:Adenoma / Q000473:pathology / Q000601:surgery*; D000368:Aged; D000369:Aged, 80 and over; D001003:Anal Canal; D016063:Blood Loss, Surgical; D002276:Carcinoid Tumor / Q000473:pathology / Q000601:surgery*; D004867:Equipment Design; D005260:Female; D006801:Humans; D020706:Laparoscopes; D010535:Laparoscopy / Q000295:instrumentation* / Q000379:methods; D008297:Male; D008866:Microsurgery / Q000295:instrumentation* / Q000379:methods; D008875:Middle Aged; D057605:Natural Orifice Endoscopic Surgery / Q000295:instrumentation* / Q000379:methods; D061646:Operative Time; D012004:Rectal Neoplasms / Q000473:pathology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome