BACKGROUND: Radical rectal resection remains the standard of care for the operative treatment of @entity5 . Local excision via transanal minimally invasive surgery (TAMIS) using disposable transanal access ports is an increasingly more common alternative for selected @entity1 . Because of significant variation in perineal anatomy, currently available disposable transanal ports do not allow adequate access for every @entity1 . This report demonstrates TAMIS for one such @entity1 via a novel approach using a single-incision laparoscopic port inserted within a disposable transanal access port. METHODS: The @entity1 is a 66-year-old @entity1 with a history of metastatic anterior uT3N0 @entity5 9  cm from the anal verge occupying 40  % of the rectal circumference. The @entity1 refused radical resection and opted for multimodality therapy with local excision. He underwent preoperative chemoradiation with good @entity5 response. The TAMIS procedure was attempted and aborted due to poor visualization and inadequate access/exposure using the commercially available Gelpoint Path transanal access system. The TAMIS procedure was reattempted and successfully completed via insertion of a laparoscopic single-incision port (GelPoint Mini) within the transanal access port itself (port-in-port technique) to overcome the deficiencies of the transanal access port. This report describes the port-in-port technique together with the stepwise approach to TAMIS. RESULTS: The TAMIS procedure was completed successfully without complications involving grossly negative margins. The @entity1 's postoperative course was uncomplicated, and he was discharged on postoperative day 1. The final pathology showed a complete pathologic response. At this writing, the @entity1 continues to do well 14  months after surgery. CONCLUSIONS: Currently available disposable transanal access ports may not allow adequate exposure for all @entity1 undergoing TAMIS. This report describes a port-in-port technique that may allow improved exposure for @entity1 with a difficult perineal anatomy.

Pushing the Limits of Local Excision for @entity5 : Transanal Minimally Invasive Surgery (TAMIS) for XXXX Using the Port-in-Port Technique.

@entity5 :: ('MESH:D009369', 'Disease') :: ['tumor', 'rectal cancer'] @entity1 :: ('9606', 'Species') :: ['patients', 'patient', 'man']
@entity5 :: (MESH:D009369,Disease) :: ['Rectal Cancer']
