Xavier Serra-Aracil1, Laura Mora-López2, Alex Casalots3, Carles Pericay4, Raul Guerrero2, Salvador Navarro-Soto2. 1. Coloproctology Unit, General and Digestive Surgery Service, Parc Taulí University Hospital, Universidad Autonoma de Barcelona, Parc Taulí 1, 08208, Sabadell, Barcelona, Spain. jserraa@tauli.cat. 2. Coloproctology Unit, General and Digestive Surgery Service, Parc Taulí University Hospital, Universidad Autonoma de Barcelona, Parc Taulí 1, 08208, Sabadell, Barcelona, Spain. 3. Pathology Service, Parc Taulí University Hospital, Universidad Autonoma de Barcelona, Sabadell, Barcelona, Spain. 4. Medical Oncology Service, Parc Taulí University Hospital, Universidad Autonoma de Barcelona, Sabadell, Barcelona, Spain.
Abstract
BACKGROUND: Laparoscopic surgery for rectal TME achieves better patient recovery, lower morbidity, and shorter hospital stay than open surgery. However, in laparoscopic rectal surgery, the overall conversion rate is nearly 20%. Transanal TME combined with laparoscopy, known as Hybrid NOTES, is a less invasive procedure that provides adequate solutions to some of the limitations of rectal laparoscopy. Transanal TME via TEO with technical variants (intracorporeal resection and anastomosis, TEO review of the anastomosis) attempts to standardize and simplify the procedure. METHOD: Prospective observational study was used describe and assess the technique in terms of conversion to open surgery, overall morbidity, surgical site infection and hospital stay. The sample comprised consecutive patients diagnosed with rectal tumor less than 10 cm from the anal verge who were candidates for low anterior resection using TME (except T4). Demographic, surgical, postoperative, and pathological variables were analyzed, as well as morbidity rates. RESULTS: From September 2012 to August 2014, 32 patients were included. The conversion rate was 0%. Overall morbidity was 31.3%, SSI rate was 9.4%, and mean hospital stay was 8 days. Oncological radical criteria were achieved with pathological parameters of 94% of complete TME and a median circumferential margin of 13 mm. CONCLUSION: The introduction of technical variants of TEO for transanal resection can facilitate a procedure that requires extensive experience in transanal and laparoscopic surgery. Studies of sphincter function, quality of life, and long-term oncological outcome are now necessary.
BACKGROUND: Laparoscopic surgery for rectal TME achieves better patient recovery, lower morbidity, and shorter hospital stay than open surgery. However, in laparoscopic rectal surgery, the overall conversion rate is nearly 20%. Transanal TME combined with laparoscopy, known as Hybrid NOTES, is a less invasive procedure that provides adequate solutions to some of the limitations of rectal laparoscopy. Transanal TME via TEO with technical variants (intracorporeal resection and anastomosis, TEO review of the anastomosis) attempts to standardize and simplify the procedure. METHOD: Prospective observational study was used describe and assess the technique in terms of conversion to open surgery, overall morbidity, surgical site infection and hospital stay. The sample comprised consecutive patients diagnosed with rectal tumor less than 10 cm from the anal verge who were candidates for low anterior resection using TME (except T4). Demographic, surgical, postoperative, and pathological variables were analyzed, as well as morbidity rates. RESULTS: From September 2012 to August 2014, 32 patients were included. The conversion rate was 0%. Overall morbidity was 31.3%, SSI rate was 9.4%, and mean hospital stay was 8 days. Oncological radical criteria were achieved with pathological parameters of 94% of complete TME and a median circumferential margin of 13 mm. CONCLUSION: The introduction of technical variants of TEO for transanal resection can facilitate a procedure that requires extensive experience in transanal and laparoscopic surgery. Studies of sphincter function, quality of life, and long-term oncological outcome are now necessary.
Authors: Gerhard F Buess; Mahesh C Misra; Hemanga K Bhattacharjee; Francisco C Becerra Garcia; Virinder K Bansal; Julio Ricardo Torres Bermudez Journal: Surg Laparosc Endosc Percutan Tech Date: 2011-06 Impact factor: 1.719
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Authors: Xavier Serra-Aracil; Laura Mora-Lopez; Manel Alcantara-Moral; Aleidis Caro-Tarrago; Carlos Javier Gomez-Diaz; Salvador Navarro-Soto Journal: World J Gastroenterol Date: 2014-09-07 Impact factor: 5.742
Authors: X Serra-Aracil; A Zárate; L Mora; S Serra-Pla; A Pallisera; J Bonfill; J Bargalló; A Pando; S Delgado; E Balleteros; C Pericay Journal: Int J Colorectal Dis Date: 2018-03-16 Impact factor: 2.571
Authors: X Serra-Aracil; S Serra-Pla; L Mora-Lopez; A Pallisera-Lloveras; M Labro-Ciurans; S Navarro-Soto Journal: Surg Endosc Date: 2018-06-22 Impact factor: 4.584
Authors: C L Deijen; A Tsai; T W A Koedam; M Veltcamp Helbach; C Sietses; A M Lacy; H J Bonjer; J B Tuynman Journal: Tech Coloproctol Date: 2016-11-16 Impact factor: 3.781