Transanal endoscopic proctectomy: a case in swine.

Laparoscopic total mesorectal excision has been proven safe and effective in the radical minimally invasive surgical treatment of rectal cancer. However, technical difficulties may impose challenges to completion of the procedure leading to an eventually high conversion rate. Transanal endoscopic proctectomy using available minimally invasive rectal surgery platforms represents an ingenious approach to surgery in the extraperitoneal rectum. It was aimed at evaluating the feasibility of this natural orifice translumenal endoscopic surgery rectosigmoid resection in the swine. Full-thickness circumferential rectal dissection was performed and extended proximally. After distal colon and rectal mobilization, the specimen was exteriorized and transected, and the proximal colon was stapled to the distal rectum. In this feasibility non-survival study, operation time was 3 h 10 min, the specimen length was 12 cm and it was intact regarding rectal wall and attached mesorectum. Injuries to adjacent organs were not observed. Transanal endoscopic proctectomy proved feasible in one swine model and might represent an option to the difficult laparoscopic total mesorectal excision.