DYNAMIC MANUSCRIPT Transanal endoscopic surgery using a single access port: a practical tool in the surgeon’s toybox I. Emre Gorgun • Erman Aytac • Meagan M. Costedio • Hasan H. Erem • Michael A. Valente • Luca Stocchi Received: 9 February 2013 / Accepted: 6 October 2013 Ó Springer Science+Business Media New York 2013 Abstract Background Large polyps and early carcinomas of the rectum may be excised with transanal endoscopic surgery (TES). Single-port techniques are emerging in the field of colorectal surgery and have been adapted to many colo- rectal procedures so far. In this article, we aimed to present our initial experience with TES using a single access port with its technical details. Patients and methods Patients undergoing TES using a single access port between July 2010 and January 2013 were included in the study. Patient demographics, opera- tive technique, and both operative and postoperative out- comes were evaluated and presented. Results A total of 12 patients (ten males) were included in our study. The median age was 63.5 years (50–84), median American Society of Anesthesiologists (ASA) score was 3 (2–4), and median body mass index was 28.8 kg/m 2 (17.4–55.6). Median operating time was 79 min (43–261). Histopathological diagnoses were as follows: tubulovillous adenoma (n = 6), tubular adenoma (n = 4), adenocarcinoma (n = 1), and neuroendocrine tumor (n = 1). Five patients were sent home on the day of surgery and the median postoperative hospital stay was 1 day (0–38). Median estimated blood loss was 22.5 ml (5–150). A transient urinary retention was developed in one patient postoperatively, and two patients had postoperative bleeding. The first of these patients with a long history of anticoagulant usage had rectal bleeding 13 days after sur- gery, which was successfully managed with medical treatment. The second patient was morbidly obese, had multiple comorbidities, and had rectal bleeding on post- operative day 7 which was managed with local epinephrine injection. He suffered unrelated cardiac death on postop- erative day 38. Conclusions TES is safe and feasible when using a single port and in the standard laparoscopic setting. The single- port technique may play a major role in the widespread utilization of TES as a treatment for large adenomas and early rectal cancers. Keywords Transanal endoscopic surgery Á Single-port access Á Rectal surgery Transanal endoscopic surgery (TES) is a treatment option for polyps not amenable to endoscopic excision, and selected carcinomas of the rectum. Transanal endoscopic microsurgery (TEM) is the earliest and most common type of TES [1]. Benefits of TES include decreased postopera- tive pain, and shorter hospital stay and recovery time when compared with conventional transabdominal surgery. When conducted by experienced surgeons, a local excision resulting in tumor-free margins results in a satisfactory quality of life associated with minimal loss of anorectal function [2]. Buess et al. [3] were the first to design a A full video describing the surgical technique and a poster including our preliminary results were presented at the Annual Meeting of the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES), Baltimore, MD, USA, 17–20 April 2013. Electronic supplementary material The online version of this article (doi:10.1007/s00464-013-3267-y) contains supplementary material, which is available to authorized users. I. Emre Gorgun (&) Á E. Aytac Á M. M. Costedio Á H. H. Erem Á M. A. Valente Á L. Stocchi Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195, USA e-mail: gorgune@ccf.org E. Aytac e-mail: eaytactr@yahoo.com 123 Surg Endosc DOI 10.1007/s00464-013-3267-y and Other Interventional Techniques