**3.3 MIS and colorectal anastomosis**

A study performed by Jeong and coauthors [4] was assembled to report an institution's experiences with transanal total mesorectal excision (TME) of rectal cancer using single-port equipment and to discuss the feasibility and safety of the technique. In the institution mentioned, 10 patients (6:4) treated with transanal TME with colorectal anastomosis were examined (**Figure 9**).

In six of 10 patients, TME was done without the use of a laparoscope.

The average time spent on the operating table was 303.5 minutes.

The distal margin was 2.1 (0.2–4.2) cm on average.

The average number of lymph nodes harvested is 17.5.

Except for one patient who had an anastomotic leak, the majority of patients began dietary intake on POD 3 and were discharged on POD 7.

#### **Figure 9.**

*Complete TME specimen (a) and sectioned (b) after abdomino-perineal resection with intact mesorectum.*

The only postoperative complication was an anastomotic leak.

Conclusions: In selected cases of rectal cancer, pure natural orifice transluminal endoscopic surgery (NOTES) TME with coloanal anastomosis was found to be healthy and feasible.
