title: Hybrid NOTES: TEO for transanal total mesorectal excision: intracorporeal resection and anastomosis.
abstract: BACKGROUND
  Laparoscopic surgery for rectal TME achieves better patient recovery, lower morbidity, and shorter hospital stay than open surgery. However, in laparoscopic rectal surgery, the overall conversion rate is nearly 20%. Transanal TME combined with laparoscopy, known as Hybrid NOTES, is a less invasive procedure that provides adequate solutions to some of the limitations of rectal laparoscopy. Transanal TME via TEO with technical variants (intracorporeal resection and anastomosis, TEO review of the anastomosis) attempts to standardize and simplify the procedure.
  
  
  METHODS
  Prospective observational study was used describe and assess the technique in terms of conversion to open surgery, overall morbidity, surgical site infection and hospital stay. The sample comprised consecutive patients diagnosed with rectal tumor less than 10 cm from the anal verge who were candidates for low anterior resection using TME (except T4). Demographic, surgical, postoperative, and pathological variables were analyzed, as well as morbidity rates.
  
  
  RESULTS
  From September 2012 to August 2014, 32 patients were included. The conversion rate was 0%. Overall morbidity was 31.3%, SSI rate was 9.4%, and mean hospital stay was 8 days. Oncological radical criteria were achieved with pathological parameters of 94% of complete TME and a median circumferential margin of 13 mm.
  
  
  CONCLUSIONS
  The introduction of technical variants of TEO for transanal resection can facilitate a procedure that requires extensive experience in transanal and laparoscopic surgery. Studies of sphincter function, quality of life, and long-term oncological outcome are now necessary.
authors: Coloproctology Unit, General and Digestive Surgery Service, Parc Taulí University Hospital, Universidad Autonoma de Barcelona, Parc Taulí 1, 08208, Sabadell, Barcelona, Spain. jserraa@tauli.cat.
authors: Xavier
authors: X
authors: Serra-Aracil
authors: Coloproctology Unit, General and Digestive Surgery Service, Parc Taulí University Hospital, Universidad Autonoma de Barcelona, Parc Taulí 1, 08208, Sabadell, Barcelona, Spain.
authors: Laura
authors: L
authors: Mora-López
authors: Pathology Service, Parc Taulí University Hospital, Universidad Autonoma de Barcelona, Sabadell, Barcelona, Spain.
authors: Alex
authors: A
authors: Casalots
authors: Medical Oncology Service, Parc Taulí University Hospital, Universidad Autonoma de Barcelona, Sabadell, Barcelona, Spain.
authors: Carles
authors: C
authors: Pericay
authors: Coloproctology Unit, General and Digestive Surgery Service, Parc Taulí University Hospital, Universidad Autonoma de Barcelona, Parc Taulí 1, 08208, Sabadell, Barcelona, Spain.
authors: Raul
authors: R
authors: Guerrero
authors: Coloproctology Unit, General and Digestive Surgery Service, Parc Taulí University Hospital, Universidad Autonoma de Barcelona, Parc Taulí 1, 08208, Sabadell, Barcelona, Spain.
authors: Salvador
authors: S
authors: Navarro-Soto
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001003:Anal Canal / Q000601:surgery; D000714:Anastomosis, Surgical; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011788:Quality of Life; D012004:Rectal Neoplasms / Q000601:surgery*; D000067368:Transanal Endoscopic Surgery / Q000379:methods*
keywords: Hybrid NOTES; NOTES; TEM; TEO; Transanal TME; Transanal excision