OBJECTIVES:Clinical natural orifice surgery has been applied for abdominal surgery in recentyears. Despite potential advantages of transcolonic NOTES for colorectal diseases,it was since now not yet clinically applied. The study describes the first successfulhuman application of transcolonic NOTES in the literature, in a new transrectalTME procedure for rectal cancer.
METHODS: IRB approval was obtained at the institution for the study,and the patient signed informed consent. In a 54yrs-old male patient with arectal adenocarcinoma, total mesorectal resection and rectosigmoidectomy withlymphadenectomy was performed using a posterior transcolonic access 3cm fromthe anal verge. Mesorectal dissection was achieved using a flexible colonoscopeand endoscopic instrumentation and laparoscopic assistance. The specimen wasextracted transanally, and transorificial anastomosis was performed, with proximalstoma.
RESULTS: Operative time was 350 min, no intraoperative complicationsoccurred. The postoperative course was uneventful, patient was discharged after6 days.
CONCLUSION: Successful first human report on Transcolonic NOTES potentiallybrings new fronteers and applications for minimally invasive surgery. The treatmentof colorectal diseases through a flexible Perirectal NOTES Access (PNA) is apromising new approach besides existing laparoscopic and open surgery to improvepatient care.
