title: Transanal total mesorectal excision: a pure NOTES approach for selected patients.
abstract: BACKGROUND
  The concept of natural orifice transluminal endoscopic surgery (NOTES) has stimulated the development of various "incisionless" procedures. One of the most popular is the transanal approach for rectal lesions. The aims of this study were to report how we standardized NOTES technique for transanal mesorectal excision without abdominal assistance, discuss the difficulties and surgical outcomes of this technique and report its feasibility in a small group of selected patients.
  
  
  METHODS
  Three consecutive female patients underwent transanal NOTES rectal resection without transabdominal laparoscopic assistance for rectal lesions. Functional results were assessed with the Fecal Incontinence Quality of Life scale and the Wexner score.
  
  
  RESULTS
  The technical steps are described in details and complemented with a video. All procedures were completed without transabdominal laparoscopic help. The mesorectal plane was entirely dissected without any disruption, and distal and circumferential margins were tumor-free. No major complications were observed. Functional results show a significant impairment after surgery with improvement at 6 months to levels near those of the preoperative period.
  
  
  CONCLUSIONS
  The performance and publication of NOTES procedures are subject to much discussion. Despite the small number of patients, this procedure appears feasible and can be accomplished maintaining fecal continence and respecting oncologic principles.
authors.affiliation: Department of General Surgery, de Braga Hospital, Braga, Portugal, pedroleao@ecsaude.uminho.pt.
authors.forename: P
authors.initials: P
authors.lastname: Leão
authors.forename: A
authors.initials: A
authors.lastname: Goulart
authors.forename: C
authors.initials: C
authors.lastname: Veiga
authors.forename: H
authors.initials: H
authors.lastname: Cristino
authors.forename: N
authors.initials: N
authors.lastname: Marcos
authors.forename: J
authors.initials: J
authors.lastname: Correia-Pinto
authors.forename: M
authors.initials: M
authors.lastname: Rodrigues
authors.forename: C
authors.initials: C
authors.lastname: Moreno-Sanz
mesh_terms: D000328:Adult; D001003:Anal Canal / Q000503:physiopathology / Q000601:surgery*; D005242:Fecal Incontinence / Q000209:etiology; D005260:Female; D006801:Humans; D008488:Medical Illustration; D008875:Middle Aged; D011788:Quality of Life; D020127:Recovery of Function; D012004:Rectal Neoplasms / Q000150:complications / Q000601:surgery*; D012007:Rectum / Q000503:physiopathology / Q000601:surgery*; D000067368:Transanal Endoscopic Surgery / Q000379:methods* / Q000592:standards