A Stepwise Approach to Transanal Endoscopic Microsurgery for Rectal Cancer Using a Single-Incision Laparoscopic Port
Annals of Surgical Oncology, 05/04/2012
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.
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.
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.