Transanal glove port is a safe and cost-effective alternative for transanal endoscopic microsurgery

Abstract

Transanal endoscopic microsurgery (TEM) is a minimally invasive technique for excision of rectal tumours that avoids conventional pelvic resectional surgery along with its risks and side-effects. Although appealing, the associated cost and complex learning curve limit TEM utilization by colorectal surgeons. Single-port laparoscopic principles are being recognized as transferable to transanal work and hybrid techniques are in evolution. Here the clinical application of a new technique for transanal access is reported. Consecutive non-selected patients eligible for TEM over a 3-month period (and selected patients thereafter) were offered a procedure performed via a 'glove TEM port'. This access device was constructed on-table using a circular anal dilator (CAD), wound retractor and standard surgical glove, along with standard, straight laparoscopic trocar sleeves and instruments. Fourteen patients underwent full-thickness resection of benign (8) or malignant (6) rectal pathology. CAD insertion failed in one patient and conventional TEM assistance was needed in another, leaving 12 procedures completed successfully by glove TEM alone as planned (completion rate 86 per cent overall, 92 per cent after initiation). The median (range) duration of operation and resected specimen area were 93 (30-120) min and 12 (3-152) cm(2) respectively. There was no intraoperative and minimal postoperative morbidity, with a median follow-up of 5.7 (2.7-9.4) months. The glove TEM port is a safe, inexpensive and readily available access tool that may obviate the use of specialized equipment for transanal resection of rectal lesions.