Dynamic article: transanal rectal excision: a pilot study.

BACKGROUND

Laparoscopic total mesorectal excision can be difficult in a narrow pelvis. Transanal minimally invasive surgery allows the surgeon to mobilize the most distal part of the rectum by using a single port positioned in the anal canal.

OBJECTIVE

We aim to assess the safety and feasibility of transanal rectal excision.

DESIGN AND SETTING

This pilot study was conducted in a university hospital and tertiary colorectal referral center in Belgium.

PATIENTS

Over a 12-month period, all consecutive patients with benign disease and ASA grade 3 patients with a rectal carcinoma who required either intersphincteric proctectomy or coloanal anastomosis were included.

INTERVENTION

After intersphincteric dissection or sleeve mucosectomy, a single-access multichannel port was inserted into the anal canal. A transanal rectal excision was performed by using conventional laparoscopic instruments. The planes were developed as cephalad as possible, until the pouch of Douglas was opened. A laparoscopically assisted approach was used to gain bowel length and was used in patients who required proctectomy. In the case of a reconstruction, a handsewn coloanal anastomosis was made.

MAIN OUTCOME MEASURES

Intraoperative challenges, conversion rate, operating time, blood loss, morbidity, and length of stay were assessed.

RESULTS

Fourteen patients underwent a transanal rectal excision for both benign (9) and malignant (5) disease. In 11 patients (79%), laparoscopically assisted transanal minimally invasive rectal excision was performed. The median (range) transanal operating time was 55 (35-95) minutes. Intraoperative difficulties hindering dissection occurred in 5 patients and were due to inadequate exposure, rectal perforation, or fibrosis secondary to radiotherapy for prostate cancer. There was minimal postoperative morbidity, with a median follow-up of 6.3 (1.5-13.8) months. All patients were discharged within 14 days postoperatively, and there were no readmissions.

LIMITATIONS

The study was limited by the small number of patients.

CONCLUSION

Transanal rectal excision is safe and feasible and could be a promising technique to facilitate distal rectal mobilization (see Video, Supplemental Digital Content 1, http://links.lww.com/DCR/A125).