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NOTES Approach Produces Another Success

Tue, 12/01/2009 - 4:42am

Another advancement in NOTES (Natural Orifice Transluminal Endoscopy Surgery) technique has been realized as surgeons used the transanal route to remove a rectal mass.

The team of surgeons carried out the first surgical removal of a rectal mass using the TEM (Transanal Endoscopic Microsurgery) technique in the Hospital Clinic of Barcelona. The successful surgery was due to a collaboration between the Gastrointestinal Surgery team of the Hospital Clinic, headed by Dr. Antonio M de Lacy, and a team of surgeons from the Massachusetts General Hospital of Boston, headed by Dr. Patricia Sylla, Instructor of Surgery at the Harvard Medical School. This is the first time in the world that a rectal tumor has been excised using an approach through the anus.

The patient, a 76-year-old woman diagnosed with a malignant rectal tumor, was discharged with no complications and excellent postoperative recovery five days after surgery. During the operation, nearly all surgical instruments were introduced through the anus to avoid painful abdominal incisions.

This new technique has been developed to achieve better results than laparoscopic surgery, and is a minimally-invasive technique that delivers less pain, shorter hospital stays and safe oncologic results.

The transanal route presents many advantages. One essential point is that it can be used in both men and women, unlike the transvaginal route. Another is the possibility of opening and closing the colon or rectum under direct vision. This is possible due to the use of techniques developed for the local treatment of rectal lesions using the TEM approach.

The TEM technique uses rectal endoscopy to introduce a specially-designed proctoscope connected to a CO2 insufflation system that dilates the rectum. This creates a working space that allows the instruments required to section and dissect the mass to be introduced. This route allows the dissection of the rectum and surrounding tissue until the abdominal cavity is reached.

Unlike other NOTES procedures, which require incisions in order to access the surgical field, the transanal approach is the only route where the tissue perforated to gain access to the diseased area is part of the tissue that will ultimately be excised. In the future, this new technique will be available to treat other diseases of the colon and rectum.

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