Transanal endoscopic surgery using single access and standard laparoscopic instrumentation.

Transanal endoscopic microsurgery (TEM) or operation (TEO) refer to the concept of performing intraluminal excision of rectal lesions with specialized, high specification equipment that maintains a stable pneumorectum and allows either high definition or binocular optical visualization of the target site along with the capacity for using precise instrumentation (including electocautery) for tissue tensioning, dissection, resection and re-apposition. However, neither technology is widely available and capital set-up costs are high. Furthermore, the rigid, elongated cylindrical configuration of the rectoscope can prove restrictive for non-expert practitioners in that it demands a rarefied and hitherto relatively non-transferrable skill-set only achievable with high volume caseloads. The advent of single port minimally invasive surgery arising on a broadened background of widespread advanced laparoscopic skills and equipment among colorectal departments along with an increasing incidence of appropriate lesions (either large dysplastic tumors or early and neoadjuvantly downstaged rectal cancers) may, however, provide the means for this approach to become more integrated into mainstream practice by the removal of these barriers for interested practitioners. While early generation devices still need adaption for perfect applicability to transanal access and oncologic standards need to be carefully maintained in parallel with increased proliferation of technical capacity, the transfer of single port techniques and access platforms to transanal work has great potential through the convergence of practice of these two niche applications. Here we present a detailed analysis of currently available single port devices (including the table-side constructed "Glove TEM Port") in transanal application and define the ideal parameters required to make this a reality.