Natural orifice surgery applied for colorectal diseases

Figure 1 Total mesorectal resection using perirectal natural orifice transluminal endoscopic surgery (NOTES) access (PNA) was progressively accomplished using endoscopic monopolar scissors (ApolloEndosurgery, Austin, TX, USA) inside the ideal oncologic plane of dissection. The endoscope is inserted directly in the presacral space, from an incision above the dentate line, allowing flexible dissection in the anatomic oncologic plane from below. (Courtesy Brazilian NOTES Research Group).

Figure 2 Full transanal extraction of the specimen with intact mesorectal resection in Transcolonic NOTES. The colonoscope is inserted directly in the perirectal retroperitoneal space through the incision, paralel to rectal lumen. (Courtesy Brazilian NOTES Research Group).

Figure 3 Postoperative aspect of the abdomen of patient submitted to rectossigmoidectomy. (Courtesy Brazilian NOTES Research Group).

Figure 4 Transcolonic retroperitoneal access (PNA) in animal model. (Courtesy Brazilian NOTES Research Group).

Figure 5 Transcolonic liver biopsy in animal model. (Courtesy Brazilian NOTES Research Group).