Skip to main content

Advertisement

SpringerLink
Log in

Atypical indications for transanal endoscopic microsurgery to avoid major surgery

  • Original Article
  • Published:
Techniques in Coloproctology Aims and scope Submit manuscript

Abstract

Background

Transanal endoscopic microsurgery (TEM) was originally designed for the removal of rectal tumors, principally incipient adenomas, and adenocarcinomas up to 20 cm from the anal verge. However, with the evolution of the technique and the increase in surgeons’ experience, new indications have emerged and TEM may now be used in place of other surgical procedures which are associated with higher morbidity. The aim of our study was to evaluate our group’s use of TEM or transanal endoscopic operations (TEO) for conditions other than rectal tumors.

Methods

An observational study of TEM (using Wolf equipment) or TEO (using Storz equipment) for indications other than excision of rectal tumors was conducted from June 2004 to July 2012.

Results

Four hundred twenty-four procedures were performed using TEM/TEO: removal of adenocarcinomas in 148 (34.9 %) patients, adenomas in 236 (55.7 %), post-polypectomy excision in 12 (2.8 %), removal of neuroendocrine tumors in 8 (1.9 %), and atypical indications in 20 (4.7 %). Atypical indications were pelvic abscess (3), benign rectal stenoses (2), rectourethral fistula after prostatectomy (3), gastrointestinal stromal tumor (3), endorectal condylomata acuminata (1), rectal prolapse (2), extraction of impacted fecaloma in the rectosigmoid junction (1), repair of traumatic and iatrogenic perforation of the rectum (2), and presacral tumor (3).

Conclusions

The use of TEM/TEO in atypical indications may benefit patients by avoiding surgical procedures associated with greater morbidity.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. 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

    CAS  PubMed  Google Scholar 

  2. Serra Aracil X, Bombardo Junca J, Mora Lopez L, Alcantara Moral M, Ayguavives Garnica I, Navarro Soto S (2006) Transanal endoscopic microsurgery (TEM). current situation and future expectations. Cir Esp 80:123–132

    Article  PubMed  Google Scholar 

  3. International training course on transanal endoscopic operations (TEO): diagnosis, technique and follow-up. Available at: http://www.teotemtauli.com/. Accessed 15 Sept 2012

  4. Ramirez JM, Aguilella V, Gracia JA et al (2009) Local full-thickness excision as first line treatment for sessile rectal adenomas: long-term results. Ann Surg 249:225–228

    Article  PubMed  Google Scholar 

  5. Serra-Aracil X, Vallverdu H, Bombardo-Junca J, Pericay-Pijaume C, Urgelles-Bosch J, Navarro-Soto S (2008) Long-term follow-up of local rectal cancer surgery by transanal endoscopic microsurgery. World J Surg 32:1162–1167

    Article  PubMed  Google Scholar 

  6. Sylla P, Rattner DW, Delgado S, Lacy AM (2010) NOTES transanal rectal cancer resection using transanal endoscopic microsurgery and laparoscopic assistance. Surg Endosc 24:1205–1210

    Article  PubMed  Google Scholar 

  7. Saclarides TJ (2007) TEM/local excision: indications, techniques, outcomes, and the future. J Surg Oncol 96:644–650

    Article  PubMed  Google Scholar 

  8. Nieuwenhuis AJ, Draaisma WA, Verberne GH, van Overbeeke 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

    Article  CAS  PubMed  Google Scholar 

  9. Serra-Aracil X, Alcantara M, Corredera C, Mora L, Navarro S (2012) Repair of rectal prolapse using transanal endoscopic surgery. Cir Esp 90:525–528

    Article  PubMed  Google Scholar 

  10. Hermoso Bosch J, Serra Aracil X, Mora Lopez L, Corredera Cantarin C (2012) Application of transanal endoscopic microsurgery (TEM) to remove an impacted faecaloma. Cir Esp 90:205–206

    Article  PubMed  Google Scholar 

  11. Serra-Aracil X, Gomez-Diaz CJ, Navarro-Soto S, Hidalgo-Rosas JM, Mora-Lopez L (2012) Repair of rectal trauma perforation using TEO. Colorectal Dis 14:e427–e428

    Article  CAS  PubMed  Google Scholar 

  12. Serra Aracil X, Gómez Díaz C, Bombardó Junca J et al (2010) S.Surgical excision of retrorectal tumour using transanal endoscopic microsurgery. Colorectal Dis 12:594–595

    Article  CAS  PubMed  Google Scholar 

  13. De Graaf EJ, Doornebosch PG, Tollenaar RA et al (2009) Transanal endoscopic microsurgery versus total mesorectal excision of T1 rectal adenocarcinomas with curative intention. Eur J Surg Oncol 35:1280–1285

    Article  PubMed  Google Scholar 

  14. Prasad ML, Read DR, Abcarian H (1981) Supralevator abscess: diagnosis and treatment. Dis Colon Rectum 24:456–461

    Article  CAS  PubMed  Google Scholar 

  15. Baatrup G, Svensen R, Ellensen VS (2010) Benign rectal strictures managed with transanal resection—a novel application for transanal endoscopic microsurgery. Colorectal Dis 12:144–146

    Article  CAS  PubMed  Google Scholar 

  16. Andrews EJ, Royce P, Farmer KC (2011) Transanal endoscopic microsurgery repair of rectourethral fistula after high-intensity focused ultrasound ablation of prostate cancer. Colorectal Dis 13:342–343

    Article  CAS  PubMed  Google Scholar 

  17. Wexner SD, Ruiz DE, Genua J, Nogueras JJ, Weiss EG, Zmora O (2008) Gracilis muscle interposition for the treatment of rectourethral, rectovaginal, and pouch-vaginal fistulas: results in 53 patients. Ann Surg 248:39–43

    Article  PubMed  Google Scholar 

  18. Miettinen M, El-Rifai W, Sobin L, Lasota J (2002) Evaluation of malignancy and prognosis of gastrointestinal stromal tumors: a review. Hum Pathol 33:478–483

    Article  PubMed  Google Scholar 

  19. Arezzo A, Verra M, Morino M (2011) Transanal endoscopic microsurgery after neoadjuvant therapy for rectal GIST. Dig Liver Dis 43:923–924

    Article  PubMed  Google Scholar 

  20. Machlenkin S, Pinsk I, Tulchinsky H et al (2011) The effect of neoadjuvant imatinib therapy on outcome and survival after rectal gastrointestinal stromal tumour. Colorectal Dis 13:1110–1115

    Article  CAS  PubMed  Google Scholar 

  21. Samaranayake CB, Luo C, Plank AW, Merrie AE, Plank LD, Bissett IP (2010) Systematic review on ventral rectopexy for rectal prolapse and intussusception. Colorectal Dis 12:504–514

    Article  CAS  PubMed  Google Scholar 

  22. Lake J, Essani R, Petrone P, Kaiser A, Asensio J, Beart R (2004) Management of foreign bodies in the rectum. Dis Colon Rectum 47:1694–1698

    Article  PubMed  Google Scholar 

  23. Moore EE, Cogbill TH, Malangoni MA et al (1990) Organ injury scaling II: pancreas, duodenum, small bowel, colon and rectum. J Trauma 30:1427–1429

    Article  CAS  PubMed  Google Scholar 

  24. Steele SR, Wolcott KE, Mullenix PS et al (2007) Colon and rectal injuries during operation Iraqi Freedom: are there any changing trends in management or outcome? Dis Colon Rectum 50:870–877

    Article  PubMed  Google Scholar 

  25. Woodfield JC, Chalmers AG, Phillips N, Sagar PM (2008) Algorithms for the surgical management of retrorectal tumours. Br J Surg 95:214–221

    Article  CAS  PubMed  Google Scholar 

  26. Zoller S, Joos A, Dinter D et al (2007) Retrorectal tumors: excision by transanal endoscopic microsurgery. Rev Esp Enferm Dig 99:547–550

    Article  CAS  PubMed  Google Scholar 

  27. Vavra P, Dostalik J, Vavrova M et al (2009) Transanal endoscopic microsurgery: a novel technique for the repair of benign rectovaginal fistula. Surgeon 7:126–127

    Article  CAS  PubMed  Google Scholar 

  28. Ben-Ishay O, Person B, Eran B, Hershkovitz D, Duek DS (2011) Rectal duplication cyst in adults treated with transanal endoscopic microsurgery. Tech Coloproctol 15:469–471

    Article  CAS  PubMed  Google Scholar 

  29. Giaccaglia V, Stefanuto A, Cavallotti C, Quintiliani A, Stipa F (2011) Transanal excision of rectal pyogenic granuloma: case report and literature review. Surg Laparosc Endosc Percutan Tech 21:e91–e92

    Article  PubMed  Google Scholar 

  30. Beunis A, Pauli S, Van Cleemput M (2008) Anastomotic leakage of a colorectal anastomosis treated by transanal endoscopic microsurgery. Acta Chir Belg 108:474–476

    CAS  PubMed  Google Scholar 

  31. Spizzirri A, Coccetta M, Cirocchi R et al (2010) Synchronous colorectal neoplasias: our experience about laparoscopic-TEM combined treatment. World J Surg Oncol 8:105

    Article  PubMed Central  PubMed  Google Scholar 

Download references

Acknowledgments

We thank the rest of the members of the Coloproctology Unit, Dr Jordi Bombardó, and Isidro Ayguavives for following the study protocol. We thank Cristina Gomez Vigo for correcting the text and Michael Maudsley for help with the English.

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Coloproctology Unit, General and Digestive Surgery Service, Parc Tauli University Hospital, Autonomous University of Barcelona, 08208, Sabadell, Barcelona, Spain

    X. Serra-Aracil, L. Mora-Lopez, M. Alcantara-Moral, C. Corredera-Cantarin, C. Gomez-Diaz & S. Navarro-Soto

Authors
  1. X. Serra-Aracil
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. L. Mora-Lopez
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M. Alcantara-Moral
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. C. Corredera-Cantarin
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. C. Gomez-Diaz
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. S. Navarro-Soto
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to X. Serra-Aracil.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Serra-Aracil, X., Mora-Lopez, L., Alcantara-Moral, M. et al. Atypical indications for transanal endoscopic microsurgery to avoid major surgery. Tech Coloproctol 18, 157–164 (2014). https://doi.org/10.1007/s10151-013-1040-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10151-013-1040-9

Keywords

Search

Navigation