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“Down-to-Up” transanal NOTES Total mesorectal excision for rectal cancer: Preliminary series of 9 patients

BACKGROUND: Applications for natural orifice translumenal endoscopic surgery (NOTES) to access the abdominal cavity have increased in recent years. Despite potential advantages of transanal and transcolonic NOTES for colorectal pathology, it has not been widely applied in the clinical setting. This...

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Autores principales: Zorron, Ricardo, Phillips, Henrique N., Wynn, Greg, Neto, Manoel P. Galvao, Coelho, Djalma, Vassallo, Ricardo C.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Medknow Publications & Media Pvt Ltd 2014
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4083547/
https://www.ncbi.nlm.nih.gov/pubmed/25013331
http://dx.doi.org/10.4103/0972-9941.134878
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author Zorron, Ricardo
Phillips, Henrique N.
Wynn, Greg
Neto, Manoel P. Galvao
Coelho, Djalma
Vassallo, Ricardo C.
author_facet Zorron, Ricardo
Phillips, Henrique N.
Wynn, Greg
Neto, Manoel P. Galvao
Coelho, Djalma
Vassallo, Ricardo C.
author_sort Zorron, Ricardo
collection PubMed
description BACKGROUND: Applications for natural orifice translumenal endoscopic surgery (NOTES) to access the abdominal cavity have increased in recent years. Despite potential advantages of transanal and transcolonic NOTES for colorectal pathology, it has not been widely applied in the clinical setting. This study describes a series of nine patients for whom we performed transanal retrograde (“Down-to-Up”) total mesorectal excision for rectal cancer. MATERIALS AND METHODS: Under IRB approval, informed consent was obtained from each patient with rectal adenocarcinoma. Rectosigmoidectomy with total mesorectal excision was performed using low rectal translumenal access to the mesorectal fascia and subsequent dissection in a retrograde fashion. This was achieved using either a single port device or flexible colonoscope with endoscopic instrumentation and laparoscopic assistance. This was followed by transanal extraction of the specimen and hand-sewn anastomosis. RESULTS: Mean operative time was 311 min. Mean hospital stay was 7.56 days. Complications occurred in two patients, and consisted of one anastomotic leakage with reoperation and one intraoperative conversion to open surgery because of impossibility to dissect the specimen. TME specimen integrity was adequate in six patients. CONCLUSION: This series suggests that a retrograde mesorectal dissection via a NOTES technique is feasible in patients with rectal adenocarcinoma. This technique may act as a complimentary part of operative treatment for rectal cancer alongside other minimally invasive strategies. Long-term follow up will be needed to assess oncological results.
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spelling pubmed-40835472014-07-10 “Down-to-Up” transanal NOTES Total mesorectal excision for rectal cancer: Preliminary series of 9 patients Zorron, Ricardo Phillips, Henrique N. Wynn, Greg Neto, Manoel P. Galvao Coelho, Djalma Vassallo, Ricardo C. J Minim Access Surg Original Article BACKGROUND: Applications for natural orifice translumenal endoscopic surgery (NOTES) to access the abdominal cavity have increased in recent years. Despite potential advantages of transanal and transcolonic NOTES for colorectal pathology, it has not been widely applied in the clinical setting. This study describes a series of nine patients for whom we performed transanal retrograde (“Down-to-Up”) total mesorectal excision for rectal cancer. MATERIALS AND METHODS: Under IRB approval, informed consent was obtained from each patient with rectal adenocarcinoma. Rectosigmoidectomy with total mesorectal excision was performed using low rectal translumenal access to the mesorectal fascia and subsequent dissection in a retrograde fashion. This was achieved using either a single port device or flexible colonoscope with endoscopic instrumentation and laparoscopic assistance. This was followed by transanal extraction of the specimen and hand-sewn anastomosis. RESULTS: Mean operative time was 311 min. Mean hospital stay was 7.56 days. Complications occurred in two patients, and consisted of one anastomotic leakage with reoperation and one intraoperative conversion to open surgery because of impossibility to dissect the specimen. TME specimen integrity was adequate in six patients. CONCLUSION: This series suggests that a retrograde mesorectal dissection via a NOTES technique is feasible in patients with rectal adenocarcinoma. This technique may act as a complimentary part of operative treatment for rectal cancer alongside other minimally invasive strategies. Long-term follow up will be needed to assess oncological results. Medknow Publications & Media Pvt Ltd 2014 /pmc/articles/PMC4083547/ /pubmed/25013331 http://dx.doi.org/10.4103/0972-9941.134878 Text en Copyright: © Journal of Minimal Access Surgery http://creativecommons.org/licenses/by-nc-sa/3.0 This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Article
Zorron, Ricardo
Phillips, Henrique N.
Wynn, Greg
Neto, Manoel P. Galvao
Coelho, Djalma
Vassallo, Ricardo C.
“Down-to-Up” transanal NOTES Total mesorectal excision for rectal cancer: Preliminary series of 9 patients
title “Down-to-Up” transanal NOTES Total mesorectal excision for rectal cancer: Preliminary series of 9 patients
title_full “Down-to-Up” transanal NOTES Total mesorectal excision for rectal cancer: Preliminary series of 9 patients
title_fullStr “Down-to-Up” transanal NOTES Total mesorectal excision for rectal cancer: Preliminary series of 9 patients
title_full_unstemmed “Down-to-Up” transanal NOTES Total mesorectal excision for rectal cancer: Preliminary series of 9 patients
title_short “Down-to-Up” transanal NOTES Total mesorectal excision for rectal cancer: Preliminary series of 9 patients
title_sort “down-to-up” transanal notes total mesorectal excision for rectal cancer: preliminary series of 9 patients
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4083547/
https://www.ncbi.nlm.nih.gov/pubmed/25013331
http://dx.doi.org/10.4103/0972-9941.134878
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