Fig. 2

Representative images of the 3 insufflation techniques: a Digital pressure (DP) technique: Notice the firm circumferential pressure with elliptical deformation of the anus creating a working seal. b Purse string (PS) suture technique: Notice the centripetal accordion deformation of the anus due to suture passage along the outer rim of the recto-anal junction. Suture tags are left long to facilitate removal. c TrAAP technique using the SILS Port: Notice that all three cannulas are in place with the designated insufflation tubing removed (see # in D section); the endoscope was inserted into its place. The red rubber insufflation catheter was inserted into a traditional cannula to establish the pneumocolon. d SILS Port anatomy: Note the clear designated insufflation tubing with a provided thee-way-stop cock (#). This was removed to facilitate endoscopic passage in this study. Three separate depth adjustable instrument ports are provided (☨). Each cannula is inserted into the SILS Port using the provided trocar (*). The SILS Port accommodates 5 mm (shown here - ☨), 10 mm, 12 mm, and 15 mm cannulas allowing for various instrumentation and optics