In the past, a variety of techniques were available for the local treatment of rectal tumors, but all of them were associated with high post-surgical morbidity. In order to remedy this situation more radical techniques were required, such as lower anterior resection or rectal amputation. Transanal Endoscopic Microsurgery was invented in the 1980s and rapidly attracted interest. This new minimally invasive technique allows optimal dissection, cutting, coagulation and suturing under vision and offers several other advantages as well.

The KARL STORZ TEO-set system comprises all the instruments required for this surgical procedure. As a reference centre for TEO, the Parc Tauli University Hospital has acquired wide experience with the technique over more than 15 years. For several years now, our TEO/TEM team has been sharing the knowledge acquired through a series of carefully designed courses and more than 20 papers published. One hundred and fifty surgeons from some 50 hospitals worldwide have trained with us. To our knowledge, 44 centers are currently implementing this technique.

In recent years, an adaptation of TEO using natural orifices (known as NOTES: natural translumenal orifice endoscopic surgery) has been applied to access the peritoneal cavity and perform intra-abdominal operations. Our extensive experience in transanal surgery using TEO, with more than 650 patients treated so far either for rectal tumors or in atypical situations, has encouraged us to use this approach in transanal surgery for TME. Benefits of this technique include the maintenance of the integrity of the abdominal wall and the reduction in the rate of trauma associated with conventional surgery. At our center, we have designed a new technical variant of hybrid NOTES: transanal TME using TEO equipment.

Resection of the specimen and anastomosis are performed intracorporeally using TEO. The anastomosis can be created at the required distance from the anal verge, and the use of TEO allows subsequent review. On this course we show the details of the technique and the results of our experience. Recently, the application of indocyanine green in laparoscopic colorectal surgery has made it possible to define the correct vascularization of the area of anastomosis. On the course we describe our experimental and clinical experience with this technique and analyse the vascularization of the tissue using the SERGREEN computer program.

We look forward to welcoming you to our seventh international training course on TEO and Hybrid-NOTES: TEO for transanal TME, and application of indocyanine green in one of Spain’s most beautiful regions!

Yours sincerely,

Xavier Serra-Aracil