Laparoscopic Transanal Treatment of Rectal Tumours

Natural orifice transluminal endoscopic surgery (NOTES) represents one of the most significant surgical innovations since the introduction of laparoscopy. Transanal endoscopic microsurgery (TEM) was first introduced in 1983 to perform endoluminal local excision of rectal lesions. In 2010, Atallah and colleagues first demonstrated the feasibility and safety of transanal minimally invasive surgery (TAMIS). The transanal approach significantly reduces the potential morbidity associated with abdominal laparoscopic approach without compromising oncological outcomes. Therefore, transanal TME (taTME) increases the quality of abdominal TME and the fulfilment of a complete mesorectal excision. According to both the National Comprehensive Cancer Network (NCCN) and American Society of Colon and Rectal Surgeons (ASCRS) practice guidelines, transanal local excision is indicated as curative procedure for early-stage and low-risk T1N0 rectal cancer or can also be considered for palliation in poor candidates for surgery. TME remains the gold-standard surgical approach in combination with neoadjuvant therapy for locally advanced stage II and III rectal cancer.