Current experience and future directions of completely NOTES colorectal resection

Figure 1 Transanal exteriorization of the rectosigmoid colon mobilized using transanal endoscopic microsurgery (TEM) only (A), and TEM with transgastric endoscopic assistance (B) in a swine survival model. Transgastric endoscopic assistance significantly increased the length of specimen that could be mobilized transanally.

Figure 2 Transanal endoscopic rectal dissection using TEM in a male human cadaver. A: Following full-thickness transection of the rectal wall, the presacral plane was entered posteriorly and total mesorectal excision was completed; B: Following mobilization of the anterior rectal wall from the posterior aspect of the prostate, the peritoneal cavity was entered.

Figure 3 Transanal endoscopic mobilization of the rectosigmoid colon using TEM with combined transgastric endoscopic assistance in a human cadaver. A double channel colonoscope was inserted transgastrically and used to help dissect the peritoneal attachments of the sigmoid colon.

Figure 4 Specimen exteriorization following transanal endoscopic mobilization of the rectosigmoid colon using TEM in a male human cadaver. Total mesorectal excision and sigmoid mesenteric dissection could be achieved.