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Rectal Resection with Total Mesorectal Excision (TME) is nowadays the standard of care for rectal turmors. However local excision of early low risk stage (T1s-T1 with G1 or SM1) could be a safe alternative. Recent literature data's support this minimally invasive approach. Transanal Endoscopic Microsurgery (TEM), introduced by Buess, is a minimally invasive procedure for removal rectal lesions that need dedicated tools. TEM is a safe procedure in terms of low recurrence rate and correct oncological outcome but suffer from high cost, long learning curve and possibility of sphinteric damage induced by rigid protoscope. To avoid these problems we present a technique for transanal excision using a single-incision laparosocpic port. In SILS-TEM technique standard laparoscopic instruments are used and the soft and smaller device prevent sphinteric damage . We propose SILS-TEM for Tis or T1 Rectal Tumor located from 4 to 12 cm from the anal verge. In all the cases nodal involvement was exclude by Transanal Ultrasound and MRI. In selected patients we also propose SILS-TEM in case of T3N0 with a complete or nearly complete (less than 20% of Residual Cancer Cells at re-staging) response at neo-adiuvant therapy (performed within a controlled study protocol). In 12 months experience we performed 10 SILS-TEM: 8 for Tis or T1 uNo and 2 for complete neoadiuvant RT-CT response cases. No mayor intraop or post-op complications were showed. 8 of 10 patients required a prolonged antibiothic therapy . Hospital discharge was from day 2 to day 4 with 1 case of readmission for pain and minor rectal wounds problem.
SILS-TEM is a safety and feasible technique for selected early stage rectal tumors. The technique is easy to perform and require a short learning curve expecially for surgeons with laparoscopic skills. No additional costs are needed and patient comfort is improved.