Abstract
Transanal endoscopic microsurgery (TEM) is a procedure for the treatment of rectal villous adenoma and early rectal tumours. It is actually the first single port access surgery (SPA) as well as a true Natural Orifice Transluminal Endoscopic Surgery (NOTES) in standard use for the last twenty years. The use of this technique and instrumentation in cholecystectomy is revisited. A feasibility study was done on porcine model. Peri-umbilical approach with the articulated TEM instruments was used for cholecystectomy. An in vivo study was started after the successful feasibility study. Cholecystectomy was performed on three consecutive porcine models using TEM instruments. Median operation time was 26.6 min. The post-op mean wound length was 3.7 cm. One gallbladder was perforated during the operation and the others were delivered intact. The instrument length was noted and the difficulty in instrument handling was documented. SPA cholecystectomy is feasible with Transanal Endoscopic Microsurgery (TEM) instruments. The special TEM technique of manipulation within a confined space is ideal for single port surgery. The TEM rectoscope can be used as a reusable single port and the instruments can be used as well but modification is suggested.
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