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This article documents the consensus of an expert group of surgeons from the Second International Trans-anal Total Mesorectal Excision (TaTME) Conference held in Paris in July 2014. It outlines three facets of the TaTME procedure: (i) the technique and its indications, (ii) training and adoption, and (iii) data collection and the TaTME registry., (Colorectal Disease © 2015 The Association of Coloproctology of Great Britain and Ireland.)

Background: The excitement surrounding natural orifice transluminal endoscopic surgery (NOTES) remains tempered by concerns over safe access and closure of transvisceral enterotomies. Research in NOTES has commonly been described as using an oral transgastric access point. Transanal endoscopic microsurgery (TEM) is a minimally invasive technique for a full-thickness resection of rectal tumors and with suture closure of the resultant defect with highly specialized instruments. This technique has been used clinically in human beings for more than 2 decades. Entry into the peritoneal cavity during a resection of rectosigmoid lesions has been described, and safe closure can be obtained., Objective: To assess the feasibility of transrectal NOTES procedures by using TEM instrumentation., Design: Three porcine and 3 human cadaver models were studied by using standard TEM instrumentation and flexible endoscopes. NOTES peritoneal access, a peritoneoscopy, a liver biopsy, and colorectal resections were performed., Results: True NOTES procedures facilitated with TEM instrumentation were successfully completed., Limitations: This was a preclinical study, and several challenges to bridging to human clinical use exist: TEM instruments are currently designed for intraluminal tasks low in the pelvis, with 5-mm to 10-mm port sizes; the cost of the TEM instruments and insufflation system; and the learning curve to perform TEM closure., Conclusions: Our preclinical study demonstrated the feasibility of several transrectal NOTES procedures, colorectal resection, and anastomosis when using TEM instrumentation. We, therefore, suggest TEM as a portal for NOTES.

Endoluminal and minimally invasive techniques have a long history and bright future in colorectal surgery. First, we will examine how old (colonoscopy) and new (laparoscopy) techniques combine in the form of laparoscopically assisted colonoscopic polypectomy for removal of "colonoscopically unresectable" colon polyps. Next, we will review the early experiences with robot-assisted minimally invasive colon resections. Lastly, we will introduce the next frontier in minimally invasive surgery, natural orifice transluminal endoscopic surgery (NOTES)., (2007 Wiley-Liss, Inc)

Local excision of rectal cancer is an attractive alternative to avoid the morbidity associated with radical rectal surgery. Oncologic concerns, specifically the inability to fully assess the status of the perirectal lymph nodes and the risk of local recurrence after local excision remain significant barriers to widespread adoption of this technique. Transanal endoscopic microsurgery is an alternative minimally invasive technique used for transanal excision of rectal polyps and tumors. It offers the advantage of better exposure, magnified stereoscopic view, and greater reach into the middle and upper rectum. This technique, combined with careful patient selection, has demonstrated optimistic results compared to standard transanal techniques and even total mesorectal excision when utilized for certain early rectal cancers.