Abstract
Purpose
Transanal endoscopic microsurgery (TEM) is a well-established surgical approach for local excision of benign adenomas and early-stage rectal cancer. This technique is expensive and associated with a long learning curve. To avoid these obstacles, we have developed an alternative approach using the EndorecTM trocar (Aspide, France), which combines the advantages of local transanal excision and single-port access. The aim of this study was to evaluate the feasibility of this technique.
Patients and methods
Fourteen consecutive patients underwent transanal resection using Endorec trocar and standard laparoscopic instruments. A retrospective evaluation of the outcome of this technique was performed.
Results
Fourteen patients were successfully operated. Rectal lesions included adenoma in ten patients, T1 adenocarcinoma in three and one T2 adenocarcinoma not amenable for abdominal surgery. The average distal margin from the anal verge was 10 cm (range 5–17 cm), and the mean diameter was 3.5 cm (range 1–5 cm). Negative margins were obtained in 13 patients (92,8 %). Median operating time was 60 min (range 20–100). The excisional area was sutured in nine patients. Median postoperative stay was 4 days (range 1–13). Postoperative complications (21 %) included postoperative fever in one patient and two patients were readmitted with rectal blood loss 6 and 15 days postoperatively and were treated with conservative measures.
Conclusions
Our current data show that transanal surgery using Endorec trocar is feasible and safe. Although long-term outcomes and definite indications should be yet evaluated, we believe that this new technique offers a promising alternative to TEM.
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References
Buess G, Hutterer F, Theiss J, Böbel M, Isselhard W, Pichlmaier H (1984) A system for a transanal endoscopic rectum operation. Chirurg 55:677–680
Léonard D, Colin JF, Remue C, Jamart J, Kartheuser A (2012) Transanal endoscopic microsurgery: long-term experience, indication expansion, and technical improvements. Surg Endosc 26:312–322
Moore JS, Cataldo PA, Osler T, Hyman NH (2008) Transanal endoscopic microsurgery is more effective than traditional transanal excision for resection of rectal masses. Dis Colon Rectum 51:1026–1030
De Graaf EJ, Doornebosch PG, Tetteroo GW, Geldof H, Hop WC (2009) Transanal endoscopic microsurgery is feasible for adenomas throughout the entire rectum: a prospective study. Dis Colon Rectum 52:1107–1113
De Graaf EJ, Burger JW, van Ijsseldijk AL, Tetteroo GW, Dawson I, Hop WC (2011) Transanal endoscopic microsurgery is superior to transanal excision of rectal adenomas. Colorectal Dis 13:762–767
Dias AR, Nahas CS, Marques CF, Nahas SC, Cecconello I (2009) Transanal endoscopic microsurgery: indications, results and controversies. Tech Coloproctol 13:105–111
Maslekar S, Pillinger SH, Sharma A, Taylor A, Monson JR (2007) Cost analysis of transanal endoscopic microsurgery for rectal tumours. Colorectal Dis 9:229–234
Salm R, Lampe H, Bustos A, Matern U (1994) Experience with TEM in Germany. Endosc Surg Allied Technol 2:251–254
Atallah S, Albert M, Larach S (2010) Transanal minimally invasive surgery: a giant leap forward. Surg Endosc 24:2200–2205
Lorenz C, Nimmesgern T, Back M, Langwieler TE (2010) Transanal single port microsurgery (TSPM) as a modified technique of transanal endoscopic microsurgery (TEM). Surg Innov 17:160–163
Khoo RE (2010) Transanal excision of a rectal adenoma using single-access laparoscopic port. Dis Colon Rectum 53:1078–1079
Dardamanis D, Theodorou D, Theodoropoulos G et al (2011) Transanal polypectomy using single incision laparoscopic instruments. World J Gastrointest Surg 3:56–58
Tuech JJ, Bridoux V, Kianifard B et al (2011) Natural orifice total mesorectal excision using transanal port and laparoscopic assistance. Eur J Surg Oncol 37:334–335
Sakamoto GD, MacKeigan JM, Senagore AJ (1991) Transanal excision of large, rectal villous adenomas. Dis Colon Rectum 34:880–885
Tuech JJ, Pessaux P, Regenet N, Ziani M, Ollier JC, Arnaud JP (2004) Endoscopic transanal resection using the urological resectoscope in the management of patients with rectal villous adenomas. Int J Colorectal Dis 19:569–573
Buess G, Kipfmüller K, Ibald R, Heintz A, Hack D, Braunstein S, Gabbert H, Junginger T (1988) Clinical results of transanal endoscopic microsurgery. Surg Endosc 2:245–250
Buess G, Theiss R, Günther M, Hutterer F, Pichlmaier H (1985) Endoscopic surgery in the rectum. Endoscopy 17:31–35
Middleton PF, Sutherland LM, Maddern GJ (2005) Transanal endoscopic microsurgery: a systematic review. Dis Colon Rectum 48:270–284
Bach SP, Hill J, Monson JR, Simson JN, Lane L, Merrie A, Warren B, Mortensen NJ (2009) A predictive model for local recurrence after transanal endoscopic microsurgery for rectal cancer. Br J Surg 96:280–290
Borschitz T, Heintz A, Junginger T (2006) The influence of histopathologic criteria on the long-term prognosis of locally excised pT1 rectal carcinomas: results of local excision (transanal endoscopic microsurgery) and immediate reoperation. Dis Colon Rectum 49:1492–1506
Denk PM, Swanström LL, Whiteford MH (2008) Transanal endoscopic microsurgical platform for natural orifice surgery. Gastrointest Endosc 68:954–959
Ayodeji ID, Hop WC, Tetteroo GW, Bonjer HJ, de Graaf EJ (2004) Ultracision Harmonic Scalpel and multifunctional tem400 instrument complement in transanal endoscopic microsurgery: a prospective study. Surg Endosc 18:1730–1737
Buess G, Mentges B, Manncke K, Starlinger M, Becker HD (1992) Technique and results of transanal endoscopic microsurgery in early rectal cancer. Am J Surg 163:63–69
Rouanet P, Saint Aubert B, Fabre JM et al (1993) Conservative treatment for low rectal carcinoma by local excision with or without radiotherapy. Br J Surg 80:1452–1456
Nagy A, Kovács T, Berki C, Jánó Z (1999) Surgical management of villous and tubulovillous adenomas of the rectum. Orv Hetil 140:2215–2219
Heintz A, Mörschel M, Junginger T (1998) Comparison of results after transanal endoscopic microsurgery and radical resection for T1 carcinoma of the rectum. Surg Endosc 12:1145–1148
Herman RM, Richter P, Walega P, Popiela T (2001) Anorectal sphincter function and rectal barostat study in patients following transanal endoscopic microsurgery. Int J Colorectal Dis 16:370–376
Christoforidis D, Cho HM, Dixon MR, Mellgren AF, Madoff RD, Finne CO (2009) Transanal endoscopic microsurgery versus conventional transanal excision for patients with early rectal cancer. Ann Surg 249:776–782
Buess G, Kipfmüller K, Hack D, Grüssner R, Heintz A, Junginger T (1988) Technique of transanal endoscopic microsurgery. Surg Endosc 2:71–75
Darwood RJ, Wheeler JM, Borley NR (2008) Transanal endoscopic microsurgery is a safe and reliable technique even for complex rectal lesions. Br J Surg 95:915–918
Steele RJ, Hershman MJ, Mortensen NJ, Armitage NC, Scholefield JH (1996) Transanal endoscopic microsurgery–initial experience from three centres in the United Kingdom. Br J Surg 83:207–210
Adam IJ, Shorthouse AJ (1998) Outcome following transanal endoscopic microsurgery. Dis Colon Rectum 41:526–527
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Bridoux, V., Schwarz, L., Suaud, L. et al. Transanal minimal invasive surgery with the EndorecTM trocar: a low cost but effective technique. Int J Colorectal Dis 29, 177–181 (2014). https://doi.org/10.1007/s00384-013-1789-3
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DOI: https://doi.org/10.1007/s00384-013-1789-3