New Disposable Transanal Endoscopic Surgery Platform: Longer Channel, Longer Reach

Background: Transanal endoscopic surgical (TES) resection using rigid transanal platforms (TEM, TEO) is associated with improved outcomes compared to traditional transanal excision (TAE) of rectal lesions. An alternative technique using a disposable single incision surgery platform was developed in 2009, transanal minimally invasive surgery (TAMIS), resulting in a surge in interest and access to transanal access platforms to perform TES. However, compared to rigid transanal access platforms, the disposable platforms do not facilitate internal rectal retraction and have limited proximal reach. A new long channel disposable transanal access platform has been developed (15 cm in length, 4cm in width) thereby facilitating endoluminal surgical access to the upper rectum and rectosigmoid colon.Methods: This is a retrospective case series report. Patient demographics and peri-operative outcome variables were recorded. The Gelpoint Path Long Channel was utilized in three patients with proximal rectal lesions that were not accessible using a standard disposable transanal access platform.Results: Three patients underwent TES excision of rectal adenomas using a long channel, disposable, transanal access platform. All patients were female, aged 51-53, BMI 23-32kg/m^2. The tumor size ranged from 2.4-8.5cm, 15-100% circumference, and proximal location from the dentate line ranged from 9-11cm. Final pathology revealed adenoma with negative margins in all three cases. The hospital length of stay ranged from 1-3 days and there were no perioperative complications. None of the patients have developed a local recurrence during the follow up period ranging from 5-11 months.Conclusions: The new long channel, disposable, transanal access platform facilitates transanal endoluminal surgical removal of lesions in the mid to upper rectum that may be difficult to reach using the standard disposable transanal access devices. We have successfully achieved 100% margin negative rate using this new device in this small series of patients with proximal rectal adenomas.