Transanal colorectal resection using natural orifice translumenal endoscopic surgery (<scp>NOTES</scp>)

<jats:p>The surgical management of rectal cancer has evolved over the past century, with total mesorectal excision (<jats:styled-content style="fixed-case">TME</jats:styled-content>) emerging as standard of care. As a result of the morbidity associated with open <jats:styled-content style="fixed-case">TME</jats:styled-content>, minimally invasive techniques have become popular. Natural orifice translumenal endoscopic surgery (<jats:styled-content style="fixed-case">NOTES</jats:styled-content>) has been held as the next revolution in surgical techniques, offering the possibility of ‘incisionless’ <jats:styled-content style="fixed-case">TME</jats:styled-content>. Early clinical series of transanal <jats:styled-content style="fixed-case">TME</jats:styled-content> with laparoscopic assistance (<jats:italic>n</jats:italic> = 72) are promising, with overall intraoperative and postoperative complication rates of 8.3% and 27.8%, respectively, similar to laparoscopic <jats:styled-content style="fixed-case">TME</jats:styled-content>. The mesorectal specimen was intact in all patients, and 94.4% had negative margins. There was no oncological recurrence in average‐risk patients at short‐term follow up, and 2‐year survivalrates in high‐risk patients were comparable to that after laparoscopic <jats:styled-content style="fixed-case">TME</jats:styled-content>. These preliminary studies demonstrate transanal <jats:styled-content style="fixed-case">NOTES TME</jats:styled-content> with laparoscopic assistance to be clinically feasible and safe given careful patient selection, surgical expertise, and appropriate procedural training. We are hopeful that with optimization of transanal instruments and surgical techniques, pure transanal <jats:styled-content style="fixed-case">NOTES TME</jats:styled-content> will become a viable alternative to open and laparoscopic <jats:styled-content style="fixed-case">TME</jats:styled-content> in the future.</jats:p>