World First: Rectal Tumor Removed Through Anus, Avoiding Painful Abdominal Incisions

Featured Article
Main Category: Colorectal Cancer
Also Included In: GastroIntestinal / Gastroenterology;  Medical Devices / Diagnostics
Article Date: 03 Dec 2009 - 2:00 PDT

email to a friend   printer friendly   opinions  

The world's first patient to have a malignant rectal tumor removed through the anus, thus avoiding painful abdominal incisions, was a 76-year old woman who was able to leave the Barcelona hospital where she was treated 5 days later, with no complications, and is said to be making an excellent recovery.

The surgeons are optimistic that the method can now be developed to treat a range of colorectal diseases, including cancer and diverticulitis, offering patients the benefit of fewer postoperative complications and a speedier recovery.

According to a report from Barcelona issued at the end of November, a team of surgeons from the Hospital Clinic Barcelona, Spain, and Massachusetts General Hospital of Boston (Harvard University) in the US, used a procedure called NOTES (Natural Orifice Transluminal Endoscopy Surgery), an innovative surgical approach that allows surgical access using the body's natural orifices.

NOTES is said to offer many benefits for the patient, including less time in hospital and speedier recovery. It also has the potential to achieve safe oncologic results better than laparoscopic surgery, because it leaves no surgical scars, whereas laparoscopic surgery requires four or five minimal incisions.

Another example of natural orifice surgery is the removal of the gallbladder through the mouth, where the surgeon inserts a tube down the esophagus, makes a small cut in the stomach or digestive tract to get into the abdominal cavity, and then removes the organ through the same route.

However, this type of minimally-invasive surgery is still at the research and development stage. And while surgery through the mouth and the vagina is relatively common, surgery through the anus is not.

The successful operation was the result of collaboration between two surgical teams from the Hospital Clinic of Barcelona and Massachusetts General Hospital. Both teams specialize in minimally-invasive surgical approaches to treat diseases of the colon and rectum.

Dr Antonio Mª de Lacy headed the Gastrointestinal Surgery team of the Hospital Clinic of Barcelona, and Dr Patricia Sylla, Instructor of Surgery at the Harvard Medical School, headed the Massachusetts General Hospital team.

Lacy has done much to widen the use of laparoscopic surgery, where small incisions are made in the abdomen, to treat colorectal cancer, and Sylla has been working since 2007 with Dr David Rattner, Professor of Surgery at the Massachusetts General Hospital and Harvard Medical School, to develop methods for use in colorectal surgery. Rattner is an expert on NOTES and co-founded the Natural Orifice Surgery Consortium for Assessment and Research (NOSCAR).

The surgery to remove the malignant rectal tumor was carried out on the 9th of November and the patient was discharged only five days later, on the 14th.

During the operation, nearly all the surgical instruments went in through the anus, thus avoiding painful incisions in the abomen.

One of the advantages of removing a tumor through the anus using this type of surgery is that the colon or rectum can be opened and closed under direct vision without having to rely on a camera. In this case the surgeons used techniques developed for Transanal Endoscopic Microsurgery (TEM), an approach that allows local treatment of rectal lesions.

With TEM, surgeons use rectal endoscopy to introduce a specially-designed proctoscope connected to a carbon dioxide insufflation system that dilates the rectum. This creates enough room for surgeons to insert instruments to section and dissect the mass. This route also allows them to dissect the rectum and surrounding tissue to reach the abdominal cavity, if necessary; a completely new approach.

Unlike other NOTES procedures where surgeons have to make incisions to access the tumor, the transanal method is the only route where the tissue they cut to gain access is part of what they are going to remove anyway (thus leaving no incision scars; the only scar to heal is the one where the tumor was attached to surrounding tissue).

The teams first tested the TEM method on pigs, then on human human cadavers.

They hope this method can also be developed to treat other diseases of the colon and rectum.

Lacy told the media that:

"We are convinced that this type of surgery will bring additional advantages to those already shown by laparoscopic surgery, reducing surgical invasiveness by eliminating abdominal incisions, and resulting in fewer postoperative complications and a speedier recovery."

Sylla added that:

"Based on this first case, I am encouraged that in the near future we will be able to offer this type of procedure to more patients. This approach could have wide use for patients with colorectal cancer, diverticulitis, and other diseases of the colon and rectum."

Source: IDIBAPS - Institut d'Investigacions Biomèdiques August Pi i Sunyer, NOSCAR.

Written by: Catharine Paddock, PhD
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today

• Additional
• References
• Citations