Natural Orifice Proctectomy Using a Transanal Endoscopic Microsurgical Technique in a Porcine Model

Background. Transanal endoscopic microsurgery (TEM) has been used for several decades for excision of neoplastic lesions in the rectum. With the development of natural orifice translumenal endoscopic surgery (NOTES) techniques, the authors describe a new method of proctectomy using a combination of TEM and NOTES principles. Methods. In a porcine model, a circumferential rectal sleeve resection was performed using TEM with flexible endoscopic assistance. The rectum was delivered through the anus, resected, and an end-to-end stapled anastomosis was performed. Results. The specimen was approximately 10 cm in length. No adjacent organ injuries or evidence of hemorrhage from the vascular pedicle or in the pelvis was observed at necropsy. Procedure time was 3 hours. Conclusion. This technique may increase the complexity of lesions accessible by TEM and may ultimately lead to the performance of total mesorectal excision using transanal techniques, reducing the morbidity of the abdominal approach.