Rectal Carcinoma: Operative Treatment, Transanal

The evolution of transanal local excision techniques was driven by the need for less invasive alternatives to radical rectal cancer resections, particularly in the management of early rectal tumors. Over the last 3 decades, conventional transanal excision through standard anoscopes has been supplanted by transanal endoluminal techniques through the use of transanal endoscopic platforms, collectively referred to as transanal endoscopic surgery (TES). Transanal endoscopic microsurgery (TEM) and was originally designed to perform submucosal or full-thickness local resection of rectal adenomas, but its use has since expanded to include the curative resection of appropriately selected early-stage rectal cancer. The advent of natural orifice transluminal endoscopic surgery (NOTES) combines the advantages of earlier techniques such as laparoscopic and robotic procedures, with respect to reduced incision size and oncological adequacy for total mesorectal excision (TME) for rectal surgery. In this chapter, current indications and contraindications for TES and taTME in the treatment of rectal cancer will be discussed, in addition to current obstacles, patient selection, preoperative preparation perioperative considerations, and complications.