This is a technique first described by Drs S Atallah, M Albert, and S Larach in 2009. It involves the use of a device that allows introduction of laparoscopic instruments into the anal canal without losing the gas in the rectum (pneumorectum). Carbon dioxide gas (CO2) is pumped into the rectum via a tube in the device to provide the distension necessary for visualisation.

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The device is inserted by applying steady manual pressure. Once seated in position, pneumorectum is established and laparoscopic instruments including graspers, thermal energy devices and needle holders can be inserted via the device (port) to perform the transanal excision. The device that Dr Chew used is Gelpoint path made by Applied Medical company.

Dr Chew uses this procedure for large polyps (larger than 3 cm) in the mid and lower rectum. However, he does not use this technique for known malignant tumours (proven by biopsy). The photographs demonstrate the different stages of polyp removal via this minimally invasive approach.

large polyp

Caption: large polyp

polyp removed wound exposed

Caption: polyp removed wound exposed

suturing of wound

Caption: suturing of wound

closed wound

Caption: closed wound