Abstract
Purpose
Transanal endoscopic microsurgery (TEM) is a three-dimensional viewing endoscopic system procedure which provides access to rectal tumors through a rectoscope. Two-dimensional transanal endoscopic operation (TEO), with the introduction of high-definition vision, achieves results that are comparable to those of the classical TEM. The main aim of the study was to compare the effectiveness of TEO and TEM systems in a prospective, randomized clinical trial.
Method
Study population: patients meeting inclusion criteria for diagnosis of rectal tumors with curative intent. Sample size, 36 patients. Patients were randomized to receive one of the two procedures. Study variables recorded were the following: preoperative data (time taken to assemble equipment, surgical time, quality of pneumorectum), postoperative morbidity and mortality, pathology study of the tumors, and economic analysis.
Results
Thirty-six patients were analyzed according to intention to treat. Two patients were excluded. The final per-protocol analysis was 34 patients. There were no significant differences in the preoperative or operative variables, quality of pneumorectum, postoperative variables, or pathology results. A trend toward benefit was observed in favor of TEO in time required for assembly, surgical suture time, and total surgical time though the differences were not statistically significant. Statistically significant differences were found in terms of the total cost of the procedure, with mean costs of 2,031 € ± 440 for TEO and 2,603 € ± 507 for TEM (95 % CI 218.15–926.486 €, p = 0.003).
Conclusion
No technical or clinical differences were observed between the results obtained with the two systems except lower cost with TEO.
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References
Buess G, Hutterer F, Theiss J, Bobel M, Isselhard W, Pichlmaier H (1984) A system for a transanal endoscopic rectum operation. Chirurg 55:677–680
Bretagnol F, Merrie A, George B, Warren BF, Mortensen NJ (2007) Local excision of rectal tumours by transanal endoscopic microsurgery. Br J Surg 94:627–633
Serra Aracil X, Bombardó Junca J, Mora López L, Alcántara Moral M, Ayguavives Garnica I, Navarro Soto S (2006) Transanal endoscopic microsurgery (TEM). Current situation and future expectations. Circ Esp 80:123–32
Mora López L, Serra Aracil J, Rebasa Cladera P et al (2007) Anorectal disorders in the immediate and late postoperative period after transanal endoscopic microsurgery. Circ Esp 82:285–289
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
Lirici MM, Di Paola M, Ponzano C, Hüscher CG (2003) Combining ultrasonic dissection and the Storz operation rectoscope. Surg Endosc 17:1292–1297
Nieuwenhuis DH, Draaisma WA, Verberne GH, van Overbeeke AJ, Consten EC (2009) Transanal endoscopic operation for rectal lesions using two-dimensional visualization and standard endoscopic instruments: a prospective cohort study and comparison with the literature. Surg Endosc 23:80–86
Langer C, Markus P, Liersch T, Fuzesi L, Becker H (2001) UltraCision or high-frequency knife in transanal endoscopic microsurgery (TEM)? Advantages of a new procedure. Surg Endosc 15:513–517
Argimon Pallás JM. Jimenez Villa (1991). Métodos de investigación. Mosby/Doyma libros (Madrid)
http://www.teotemtauli.com/. [Accessed: July 15, 2013]
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
Tytherleigh MG, Warren BF, Mortensen NJ (2008) Management of early rectal cancer. Br J Surg 95:409–423
Ramirez JM, Aguilella V, Gracia JA et al (2009) Local full-thickness excision as first line treatment for sessile rectal adenomas. Ann Surg 249:225–228
Guerrieri M, Baldarelli M, de Sanctis A, Campagnacci R, Rimini M, Lezoche E (2010) Treatment of rectal adenomas by transanal endoscopic microsurgery: 15 years’ experience. Surg Endocr 24:445–449
Acknowledgments
We would like to thank the members of the Coloproctology Unit, Dr Jordi Bombardó, Isidro Ayguavives, and Marina Retamar, and the residents at the Coloproctology Unit who followed the study protocol. We also thank Cristina Gomez-Vigo for correcting the manuscript and to Michael Maudsley for the translation into English. We are grateful to the nurses of the Surgery Unit for their support in the use of the procedures.
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Trial registration: ClinicalTrials.gov. Registration number: NCT01498354. Name of trial registry: Efficiency of Two Dimensional High Definition Versus Three Dimensional Endoscopic Systems in Transanal Endoscopic Surgery. URL:http://www.clinicaltrials.gov.
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Serra-Aracil, X., Mora-Lopez, L., Alcantara-Moral, M. et al. Transanal endoscopic microsurgery with 3-D (TEM) or high-definition 2-D transanal endoscopic operation (TEO) for rectal tumors. A prospective, randomized clinical trial. Int J Colorectal Dis 29, 605–610 (2014). https://doi.org/10.1007/s00384-014-1849-3
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DOI: https://doi.org/10.1007/s00384-014-1849-3