title: Transanal minimally invasive rectal resection for deep endometriosis: a promising technique.
abstract: OBJECTIVE
  Surgical management of patients with deep endometriosis (DE) of the rectum is difficult. Inflammation and subsequent adhesions due to DE impede access to the lower pelvis and may lead to complications during laparoscopic low anterior resection (LAR). Transanal minimally invasive surgery (TAMIS) is an alternative to an abdominal approach with potential advantages. The aim of this study was to provide a description of the TAMIS technique and to present the perioperative results of TAMIS and of conventional LAR in patients with DE.
  
  
  METHODS
  A prospective consecutive cohort of patients undergoing rectal resection for DE had either conventional laparoscopic LAR or TAMIS rectal excision. Pre-, intra- and postoperative parameters, such as patient symptomatology, operating time and postoperative complications were compared between the groups. Quality of life was assessed using the EORTC-QLQ-29/30 questionnaires.
  
  
  RESULTS
  Between May 2014 and March 2016 a total of 11 rectal resections were performed, including five TAMIS procedures. No differences were found in the pre-, intra- or postoperative parameters. Two major complications occurred after conventional LAR and none after TAMIS. No differences in quality of life were found between the groups.
  
  
  CONCLUSIONS
  Transanal minimally invasive surgery for DE of the rectum is feasible. Potential advantages include better surgical access to the pelvis, possibly fewer complications than LAR and no extraction incision with no difference in quality of life. Larger prospective studies are required to compare TAMIS with conventional rectal resection.
authors.affiliation: Endometriosis Centre, VU University Medical Center, Amsterdam, The Netherlands.|Department of Surgery, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: S L
authors.initials: SL
authors.lastname: Vlek
authors.affiliation: Endometriosis Centre, VU University Medical Center, Amsterdam, The Netherlands.|Department of Reproductive Medicine, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: M C I
authors.initials: MCI
authors.lastname: Lier
authors.affiliation: Department of Surgery, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: T W A
authors.initials: TWA
authors.lastname: Koedam
authors.affiliation: Endometriosis Centre, VU University Medical Center, Amsterdam, The Netherlands.|Department of Reproductive Medicine, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: I
authors.initials: I
authors.lastname: Melgers
authors.affiliation: Endometriosis Centre, VU University Medical Center, Amsterdam, The Netherlands.|Department of Reproductive Medicine, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: J J M L
authors.initials: JJML
authors.lastname: Dekker
authors.affiliation: Department of Surgery, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: J H
authors.initials: JH
authors.lastname: Bonjer
authors.affiliation: Endometriosis Centre, VU University Medical Center, Amsterdam, The Netherlands.|Department of Reproductive Medicine, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: V
authors.initials: V
authors.lastname: Mijatovic
authors.affiliation: Endometriosis Centre, VU University Medical Center, Amsterdam, The Netherlands.|Department of Surgery, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: J B
authors.initials: JB
authors.lastname: Tuynman
mesh_terms: D000005:Abdomen / Q000601:surgery; D000328:Adult; D004715:Endometriosis / Q000473:pathology / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods; D061646:Operative Time; D011183:Postoperative Complications / Q000209:etiology*; D011446:Prospective Studies; D012002:Rectal Diseases / Q000473:pathology / Q000601:surgery*; D012007:Rectum / Q000601:surgery*; D000067368:Transanal Endoscopic Surgery / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome
keywords: Endometriosis; TAMIS; rectum