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NOTES Transanal Colorectal Resection

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NOTES and Endoluminal Surgery

Part of the book series: Clinical Gastroenterology ((CG))

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Abstract

The transanal natural orifice translumenal endoscopic surgery (NOTES) approach for rectal cancer is one of the few NOTES applications that has successfully transitioned from experimental model to clinical practice. Transanal NOTES total mesorectal excision (taTME) facilitates the completion of minimally invasive, sphincter-preserving, total mesorectal excision (TME) in patients with distal rectal tumors who would otherwise require abdominoperineal resection (APR) or conversion from laparoscopic to open TME. This chapter reviews the evolution of transanal NOTES applied to colorectal surgery, as well as the most recent published outcomes of taTME to date, for both benign and malignant indications. A detailed description of laparoscopic-assisted taTME for a low rectal tumor is provided, with description of instrumentation, team, and operative setup and related technical pearls. The chapter emphasizes appropriate patient and tumor selection, a stepwise approach during transanal dissection, troubleshooting, and the recommended training pathway for taTME, all of which are critical to achieve an adequate oncologic resection and favorable perioperative outcomes in patients with rectal cancer.

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Abbreviations

ACOSOG:

American College of Surgeons Oncology Group

ALaCaRT:

Australasian laparoscopic cancer of the rectum trial

APR:

Abdominoperineal resection

CLASSICC trial:

Conventional versus laparoscopic-assisted surgery in colorectal cancer

COLOR II trial:

Colorectal cancer laparoscopic or open resection

COREAN trial:

Comparison of open versus laparoscopic surgery for mid- and low rectal cancer after neoadjuvant chemoradiotherapy

CRM:

Circumferential radial margin

CT:

Computed tomography

DRE:

Digital rectal examination

ELAPE:

Extralevator abdominoperineal excision

FAP:

Familial adenomatous polyposis

ICG:

Indocyanine green

IPAA:

Ileal pouch-anal anastomosis

IRB:

Institutional review board

ISR:

Intersphincteric resection

LOREC:

Low rectal cancer (pertains to an international tumor registry)

MRI:

Magnetic resonance imaging

NOSE:

Natural orifice specimen extraction

NOTES:

Natural orifice translumenal endoscopic surgery

PPH:

Procedure for prolapsed hemorrhoid

ROLARR:

Robotic versus laparoscopic resection for rectal cancer

TAMIS:

Transanal minimally invasive surgery

TAP:

Transversus abdominis plane

TATA:

Transanal transabdominal

taTME:

Transanal NOTES total mesorectal excision

TEM:

Transanal endoscopic microsurgery

TEO:

Transanal endoscopic operating system

TES:

Transanal endoscopic surgery

TME:

Total mesorectal excision

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Authors and Affiliations

  1. Department of Surgery, Division of Colon and Rectal Surgery, Icahn School of Medicine at Mount Sinai, 5 East 98th Street, Box 1259, New York, NY, 10029, USA

    Anthony P. D’Andrea & Patricia Sylla

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  1. Anthony P. D’Andrea
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  2. Patricia Sylla
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Correspondence to Patricia Sylla .

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Editors and Affiliations

  1. Department of Surgery, University of Massachusetts / Baystate Medical Center, Springfield, Massachusetts, USA

    John R. Romanelli

  2. Division of Gastroenterology, University of Massachusetts / Baystate Medical Center, Springfield, Massachusetts, USA

    David J. Desilets

  3. Lowell Surgical Associates , North Chelmsford, Massachusetts, USA

    David B. Earle

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D’Andrea, A.P., Sylla, P. (2017). NOTES Transanal Colorectal Resection. In: Romanelli, J., Desilets, D., Earle, D. (eds) NOTES and Endoluminal Surgery. Clinical Gastroenterology. Springer, Cham. https://doi.org/10.1007/978-3-319-50610-4_21

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