A Stepwise Approach to Transanal Endoscopic Microsurgery for Rectal Cancer Using a Single-Incision Laparoscopic Port

Smith RA et al. – Transanal endoscopic microsurgery (TEM) using a single–incision laparoscopic (SILS) port is an effective technique for the local excision of mid–upper rectal cancer in well–selected patients.

Methods

• Authors present a stepwise technique for TEM using a single–incision laparoscopic (SILS) port.
• The patient is a 64 year–old male with a right anterolateral rectal polyp 7 cm from the anal verge, which on snare polypectomy demonstrated in–situ carcinoma with positive margins.
• Endoscopic ultrasound demonstrated uT1 disease with no lymphadenopathy.
• He opted for local excision and underwent TEM.
• The stepwise approach includes: (1) delineation of excision margins, (2) full thickness incision of the rectal wall, (3) circumferential dissection, and full thickness excision, and (4) suture repair.

Results

• The procedure was performed without intraoperative or postoperative complications.
• Final pathology revealed in–situ carcinoma with widely negative margins.
• At 1– and 3–week follow–up visits, the patient was pain free with normal bowel activity and no rectal bleeding or genitourinary dysfunction.

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