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Hahn SJ, Sylla P. Technological Advances in the Surgical Treatment of Colorectal Cancer. Surg Oncol Clin N Am 2022; 31:183-218. [DOI: 10.1016/j.soc.2022.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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DE Vincenti R, Cianchi F, Coratti F. Non-conventional applications for Transanal endoscopic microsurgery. A single centre experience and a systematic review of literature. Minerva Surg 2021; 77:147-156. [PMID: 34047531 DOI: 10.23736/s2724-5691.21.08774-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Transanal endoscopic microsurgery (TEM) and Transanal endoscopic operation (TEO) have been initially described for local excision of rectal adenomas and selected cases of rectal carcinomas. In the past decade, however, several new indications raised, and others could raise in the future. The aim of this review was to evaluate, both in the literature and in our personal experience, the use of TEM and TEO for nonconventional applications, different from rectal tumors. METHODS We conducted a systematic review of published papers and we selected articles reporting patients who underwent endoscopic surgery for other medical reason than polyp cancer resection, with TEM or TEO. PubMed, MEDLINE, EMBASE and bibliographies of the selected studies were searched for articles in English published up to May 2020 to identify all relevant articles. We excluded articles reporting TEM and TEO used for classical indications. We finally report our experience of non-conventional use of TEO in 5 patients with different diseases. RESULTS The research revealed 800 papers and among them we selected 52 articles for a total of 697 patients. Of all patients, only 52 had intraoperative or postoperative complications, with only 10 patients requiring major surgery. CONCLUSIONS Our study suggest that TEM and TEO may be valid alternatives to traditional surgery in situations other than its classical indication. These findings can positively impact on the care of patients, who could benefit from less invasive surgical procedures associated with lower morbidity.
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Affiliation(s)
- Rosita DE Vincenti
- General Surgery Department, Careggi Hospital, University of Florence, Florence, Italy -
| | - Fabio Cianchi
- General Surgery Department, Careggi Hospital, University of Florence, Florence, Italy
| | - Francesco Coratti
- General Surgery Department, Careggi Hospital, University of Florence, Florence, Italy
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de Lima RDAL, Parra RS, Feitosa MR, Feres O, da Rocha JJR. Surgical and postoperative evaluations of rectal adenomas excised with a rigid proctoscope. Acta Cir Bras 2020; 35:e202000807. [PMID: 32965304 PMCID: PMC7518222 DOI: 10.1590/s0102-865020200080000007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 06/05/2020] [Accepted: 07/07/2020] [Indexed: 11/21/2022] Open
Abstract
PURPOSE This study presents the surgical and postoperative results achieved with a rigid proctoscope using the transanal endoscopic technique to excise rectal adenomas. The results are compared to the results obtained with other currently employed transanal techniques. METHODS We investigated the medical records of patients who underwent transanal endoscopic operations from April 2000 to June 2018 at two tertiary referral centers for colorectal cancer. RESULTS This study included 99 patients. The mean age was 65.3 ± 13.3 years. The average size of the adenomas was 4.6 ± 2.3 cm, and their average distance to the anal border was 5.6 ± 3.3 cm. The average operative time was 65.3 ± 41.7 min. In 48.5% of the operations, the specimen was fragmented, and in 59.6% of the cases, the microscopic margins were free. The rates of postoperative complications and relapse were 5% and 19%, respectively. The mean follow-up was 80 ± 61.5 months. CONCLUSIONS The described proctoscope proved to be a viable technique with results similar to other techniques, with the advantage that it allowed greater accessibility for surgeons. Therefore, its use could be implemented and become widespread in surgical practice.
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Affiliation(s)
- Roberta Denise Alkmin Lopes de Lima
- Fellow PhD degree, Postgraduate Program in Surgical Clinic, Division of Coloproctology, Department of Anatomy and Surgery, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo (FMRP-USP), Ribeirao Preto-SP, Brazil. Substantive scientific and intellectual contributions; conception and design of the study; acquisition, analysis and interpretation of data; manuscript preparation, final approval
| | - Rogério Serafim Parra
- PhD, Division of Coloproctology, Department of Anatomy and Surgery, FMRP-USP, Ribeirao Preto-SP, Brazil. Substantive scientific and intellectual contributions, manuscript writing, critical revision, final approval
| | - Marley Ribeiro Feitosa
- PhD, Division of Coloproctology, Department of Anatomy and Surgery, FMRP-USP, Ribeirao Preto-SP, Brazil. Substantive scientific and intellectual contributions, analysis and interpretation of data, statistics analysis, final approval
| | - Omar Feres
- PhD, Associated Professor, Division of Coloproctology, Department of Anatomy and Surgery, FMRP-USP, Ribeirao Preto-SP, Brazil. Substantive scientific and intellectual contributions, analysis and interpretation of data, critical revision, final approval
| | - José Joaquim Ribeiro da Rocha
- PhD, Associated Professor, Head, Division of Coloproctology, Department of Anatomy and Surgery, FMRP-USP, Ribeirao Preto-SP, Brazil. Substantive scientific and intellectual contributions; conception and design of the study; acquisition, analysis and interpretation of data; critical revision, final approval
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Abstract
Minimally invasive techniques continue to transform the field of colorectal surgery. Because traditional surgical approaches for rectal cancer are associated with significant mortality and morbidity, developing less invasive approaches to this disease is paramount. Natural orifice transluminal endoscopic surgery (NOTES), commonly known as "no incision surgery," represents the ultimate minimally invasive approach to disease. Although transgastric and transvaginal approaches for NOTES surgery were the initially explored, a transrectal approach for colorectal disease is intuitive given that it makes use of the resected organ for transluminal access. Furthermore, the transanal approach allows for improved, precise visualization of the presacral mesorectal plane compared with an abdominal viewpoint, particularly in the narrow, male pelvis. Finally, experience with existing transanal platforms that have been used for decades for local excision of rectal disease made the development of a transanal approach to total mesorectal excision (TME) feasible. Here, we will review the evolution of minimally invasive and transanal surgical techniques that allowed for the development of transanal TME and its introduction into clinical practice.
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Affiliation(s)
- Heather Carmichael
- Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado
| | - Patricia Sylla
- Icahn School Medicine at Mount Sinai, New York, New York
- Division of Colon and Rectal Surgery, Department of Surgery, Mount Sinai Hospital, New York, New York
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D'Hondt M, Yoshihara E, Dedrye L, Vindevoghel K, Nuytens F, Pottel H. Transanal Endoscopic Operation for Benign Rectal Lesions and T1 Carcinoma. JSLS 2017; 21:JSLS.2016.00093. [PMID: 28144126 PMCID: PMC5266515 DOI: 10.4293/jsls.2016.00093] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background and Objectives: Transanal endoscopic operation (TEO) is a minimally invasive technique used for local excision of benign and selected malignant rectal lesions. The purpose of this study was to investigate the feasibility, safety, and oncological outcomes of the procedure and to report the experience in 3 centers. Methods: Retrospective review of a prospectively collected database was performed of all patients with benign lesions or ≤cT1N0 rectal cancer who underwent TEO with curative intent at 3 Belgian centers (2012 through 2014). Results: Eighty-three patients underwent 84 TEOs for 89 rectal lesions (37 adenomas, 43 adenocarcinomas, 1 gastrointestinal stromal tumor, 1 lipoma, 2 neuroendocrine tumors, and 5 scar tissues). Operative time was associated with lesion size (P < .001). Postoperative complications occurred in 13 patients: 7 hemorrhages, 1 urinary tract infection, 1 urinary retention, 2 abscesses, 1 anastomotic stenosis, and 1 entrance into the peritoneal cavity. Median hospital stay was 3 days (range, 1–8). During a median follow-up of 13 months (range, 2–27), there was 1 recurrence. Conclusion: Although longer follow-up is still necessary, TEO appears to be an effective method of excising benign tumors and low-risk T1 carcinomas of the rectum. However, TEO should be considered as part of the diagnostic work-up. Furthermore, the resected specimen of a TEO procedure allows adequate local staging in contrast to an endoscopic piecemeal excision. Nevertheless, definitive histology must be appreciated, and in case of unfavorable histology, radical salvage resection still has to be performed.
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Affiliation(s)
- Mathieu D'Hondt
- Department of General and Digestive Surgery, Groeninge Hospital, Kortrijk, Belgium
| | - Emi Yoshihara
- Department of General and Digestive Surgery, Groeninge Hospital, Kortrijk, Belgium
| | - Lieven Dedrye
- Department of General and Digestive Surgery, Jan Yperman Hospital, Ieper, Belgium
| | - Koen Vindevoghel
- Department of General and Digestive Surgery, OLV van Lourdes Hospital, Waregem, Belgium
| | - Frederiek Nuytens
- Department of General and Digestive Surgery, Groeninge Hospital, Kortrijk, Belgium
| | - Hans Pottel
- Interdisciplinary Research Center, Catholic University Leuven, Kortrijk, Belgium
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Leong KJ, Evans J, Davies MM, Scott A, Lidder P. Transanal endoscopic surgery: past, present and future. Br J Hosp Med (Lond) 2016; 77:394-402. [PMID: 27388378 DOI: 10.12968/hmed.2016.77.7.394] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Transanal endoscopic surgery is a safe, established technique to remove lesions in the rectum via the anus. This article reviews its evolution, approaches, indications and evidence for its role in treating benign rectal polyps. The future of transanal endoscopic surgery in rectal cancer and inflammatory bowel disease is also explored.
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Affiliation(s)
- Kai J Leong
- Specialty Registrar in the Department of Colorectal Surgery, University Hospitals of Coventry and Warwickshire NHS Trust, Coventry CV2 2DX
| | - John Evans
- Consultant Colorectal Surgeon in the Department of Colorectal Surgery, Northampton General Hospital NHS Trust, Northampton
| | - Michael M Davies
- Consultant Colorectal Surgeon in the Department of Colorectal Surgery, University Hospital of Wales, Cardiff
| | - Adam Scott
- Consultant Colorectal Surgeon in the Department of Colorectal Surgery, Leicester General Hospital, University Hospitals of Leicester NHS Trust, Leicester
| | - Paul Lidder
- Consultant Colorectal Surgeon in the Department of Surgery, Royal Cornwall Hospitals NHS Trust, Cornwall
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Transanal Endoscopic Microsurgery: Current and Future Perspectives. Surg Laparosc Endosc Percutan Tech 2016; 26:e46-9. [DOI: 10.1097/sle.0000000000000273] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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9
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Swift JP, Hershman MJ. A training programme for operating theatre personnel in transanal endoscopic operation procedures for local excision of rectal tumours. J Perioper Pract 2015; 25:105-10. [PMID: 26302591 DOI: 10.1177/175045891502500603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The transanal endoscopic operation (TEO) is a minimal access surgical procedure for the removal of benign and early malignant rectal tumours (Nieuwenhuis et al 2009). This surgery involves specialist equipment, set up and positioning by the perioperative team. We report on and evaluate the first ever TEO course designed specifically for theatre practitioners.
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García-Flórez LJ, Otero-Díez JL. Local excision by transanal endoscopic surgery. World J Gastroenterol 2015; 21:9286-9296. [PMID: 26309355 PMCID: PMC4541381 DOI: 10.3748/wjg.v21.i31.9286] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Revised: 05/10/2015] [Accepted: 07/03/2015] [Indexed: 02/06/2023] Open
Abstract
Transanal endoscopic surgery (TES) consists of a series of anorectal surgical procedures using different devices that are introduced into the anal canal. TES has been developed significantly since it was first used in the 1980s. The key point for the success of these techniques is how accurately patients are selected. The main indication was the resection of endoscopically unresectable adenomas. In recent years, these techniques have become more widespread which has allowed them to be applied in conservative rectal procedures for both benign diseases and selected cases of rectal cancer. For more advanced rectal cancers it should be considered palliative or, in some controlled trials, experimental. The role of newer endoscopic techniques available has not yet been defined. TES may allow for new strategies in the treatment of rectal pathology, like transanal natural orifice transluminal endoscopic surgery or total mesorectal excision.
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Mora López L, Serra Aracil X, Hermoso Bosch J, Rebasa P, Navarro Soto S. Study of anorectal function after transanal endoscopic surgery. Int J Surg 2014; 13:142-147. [PMID: 25486265 DOI: 10.1016/j.ijsu.2014.11.021] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Revised: 11/17/2014] [Accepted: 11/21/2014] [Indexed: 10/24/2022]
Abstract
AIM To evaluate the impact of Transanal Endoscopic Microsurgery (TEM) on anorectal function, using clinical and manometric assessments. To identify subgroups likely to develop incontinence after TEM, by stratifying the sample. METHOD Descriptive, prospective study. Between December 2004 and May 2011, 222 patients were operated on at our hospital, of whom 21 were excluded from the study. Patients underwent anal manometry and answered a clinical incontinence questionnaire (the Wexner scale) prior to surgery, one month post-surgery, and then at four months post-surgery. RESULTS There were no statistically significant differences between preoperative Wexner questionnaire scores and values at one month and four months post-surgery. Preoperative baseline pressure (BP) values were 64 mmHg±26.18, falling to 44.26 mmHg±20.11 at one month and to 48.86 mmHg±21.14 at four months. Voluntary Contraction Pressure (VCP) reached preoperative values of 200.49 mmHg±88.85, falling to 169.5 mmHg±84.95 and to 173.6±79 at four months. The differences in BP and VCP were statistically significant. The sample was stratified in order to identify subsets susceptible to incontinence after surgery, but no at-risk subgroups were found. Multivariate analysis did not detect any predictors of incontinence. CONCLUSION The sustained, controlled anal dilatation produced with TEM caused statistically significant decreases in VCP and BP one month and four months after surgery. However, the Wexner questionnaire scores did not show any association with clinical incontinence. No predictors of postoperative incontinence were observed. We conclude that TEM is a safe technique and does not affect continence.
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Affiliation(s)
- L Mora López
- Coloproctology Unit, General and Digestive Surgery, Hospital Univeristari Parc Tauli, Sabadell, Barcelona, Spain.
| | - X Serra Aracil
- Coloproctology Unit, General and Digestive Surgery, Hospital Univeristari Parc Tauli, Sabadell, Barcelona, Spain
| | - J Hermoso Bosch
- Coloproctology Unit, General and Digestive Surgery, Hospital Univeristari Parc Tauli, Sabadell, Barcelona, Spain
| | - P Rebasa
- Gastroenterology Unit, General and Digestive Surgery, Hospital Univeristari Parc Tauli, Sabadell, Barcelona, Spain
| | - S Navarro Soto
- Gastroenterology Unit, General and Digestive Surgery, Hospital Univeristari Parc Tauli, Sabadell, Barcelona, Spain
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Serra-Aracil X, Mora-Lopez L, Alcantara-Moral M, Caro-Tarrago A, Gomez-Diaz CJ, Navarro-Soto S. Transanal endoscopic surgery in rectal cancer. World J Gastroenterol 2014; 20:11538-11545. [PMID: 25206260 PMCID: PMC4155346 DOI: 10.3748/wjg.v20.i33.11538] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2013] [Revised: 07/03/2014] [Accepted: 07/25/2014] [Indexed: 02/06/2023] Open
Abstract
Total mesorectal excision (TME) is the standard treatment for rectal cancer, but complications are frequent and rates of morbidity, mortality and genitourinary alterations are high. Transanal endoscopic microsurgery (TEM) allows preservation of the anal sphincters and, via its vision system through a rectoscope, allows access to rectal tumors located as far as 20 cm from the anal verge. The capacity of local surgery to cure rectal cancer depends on the risk of lymph node invasion. This means that correct preoperative staging of the rectal tumor is necessary. Currently, local surgery is indicated for rectal adenomas and adenocarcinomas invading the submucosa, but not beyond (T1). Here we describe the standard technique for TEM, the different types of equipment used, and the technical limitations of this approach. TEM to remove rectal adenoma should be performed in the same way as if the lesion were an adenocarcinoma, due to the high percentage of infiltrating adenocarcinomas in these lesions. In spite of the generally good results with T1, some authors have published surprisingly high recurrence rates; this is due to the existence of two types of lesions, tumors with good and poor prognosis, divided according to histological and surgical factors. The standard treatment for rectal adenocarcinoma T2N0M0 is TME without adjuvant therapy. In this type of adenocarcinoma, local surgery obtains the best results when complete pathological response has been achieved with previous chemoradiotherapy. The results with chemoradiotherapy and TEM are encouraging, but the scientific evidence remains limited at present.
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Transanal endoscopic surgery with total wall excision is required with rectal adenomas due to the high frequency of adenocarcinoma. Dis Colon Rectum 2014; 57:823-9. [PMID: 24901682 DOI: 10.1097/dcr.0000000000000139] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Colorectal adenomatous polyps are considered premalignant lesions, although a high percentage are already malignant at the time of their removal. Full-thickness excision in patients with adenoma detected in preoperative biopsy enables much more accurate pathology examination and has shown that local surgery is appropriate for T1 adenocarcinoma. OBJECTIVE To determine whether full-thickness excision during transanal endoscopic surgery is the treatment of choice for rectal adenoma, and to identify possible predictors of invasive adenocarcinoma associated with this type of lesion. DESIGN Prospective, observational study. SETTING The study was conducted at a university teaching hospital. PATIENTS All patients scheduled for transanal endoscopic surgery after detection of adenoma in a preoperative biopsy between June 2004 and February 2013 entered the study. MAIN OUTCOME MEASURES The principal variable was the presence of invasive adenocarcinoma in the pathology study. Other study variables were the epidemiological variables sex and age; the clinical variables tumor size, number of quadrants affected, distance from the anal verge, and tumor location; and the morphological variables tumor aspect, degree of dysplasia, preoperative biopsy (tubulo-villous), endorectal ultrasound, and pelvic MRI stage. Variables found to be related to the risk of malignancy in rectal adenomas were evaluated using univariate and multivariate analysis. RESULTS Of 471 patients who underwent surgery, 277 had a preoperative diagnosis of adenoma. Final pathology studies showed 52 (18.8%) invasive adenocarcinomas, among which 27 were pT1 (52%), 16 pT2 (30.7%), and 9 pT3 (17.3%). Factors predictive of invasive adenocarcinoma were sessile morphology (OR 3.2, 95%CI 1.4-7.1), high-grade dysplasia (OR 2.3, 95%CI 1.2-4.8), and endorectal ultrasound stage uT2-T3 (OR 3.8, 95%CI 1.6-9). LIMITATIONS The limitations are derived from the observational design. CONCLUSIONS In this sample, half of the adenocarcinomas from adenomas were T1 adenocarcinomas. Because a high proportion of rectal adenomas are, in fact, invasive adenocarcinomas, full-thickness excision is appropriate.
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Martin-Perez B, Andrade-Ribeiro GD, Hunter L, Atallah S. A systematic review of transanal minimally invasive surgery (TAMIS) from 2010 to 2013. Tech Coloproctol 2014; 18:775-88. [PMID: 24848524 DOI: 10.1007/s10151-014-1148-6] [Citation(s) in RCA: 155] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Accepted: 04/10/2014] [Indexed: 12/13/2022]
Abstract
Transanal minimally invasive surgery (TAMIS) was introduced as an alternative to transanal endoscopic microsurgery in 2010. Over the past 4 years, considerable international experience has been gained with this approach. Most published reports focus on TAMIS for local excision of rectal neoplasia, but there are other important applications such as transanal mesorectal excision for rectal cancer. This comprehensive review details the progress with TAMIS since its inception. Robotic transanal surgery is a natural evolution of TAMIS still in its early infancy, which is also reviewed. A comprehensive search of PubMed, EMBASE, the Cochrane Library, and Web of Knowledge was performed. Since the inception of TAMIS in 2009, 33 retrospective studies and case reports, and 3 abstracts have been published on TAMIS for local excision of rectal neoplasms, which represents a combined n = 390 TAMIS procedures performed worldwide using eight different types of TAMIS platforms. A total of 152 lesions were excised for benign disease including adenomas and high-grade dysplasias (39 %), 209 for malignancy for carcinomas in situ and adenocarcinomas (53.5 %). Twenty-nine (7.5 %) of TAMIS resections were for other pathology, of which the majority (23/29) were neuroendocrine lesions. The remaining resections were for mucocele, gastrointestinal stromal tumor, melanoma, and fibrosis. Robotic-TAMIS has also been reported, however, data are extremely limited as there are only 7 case reports (combined n = 11) in the published literature. Success with Robotic-TAMIS has been demonstrated with various patient positions and by use of a special glove port. Transanal total mesorectal excision using the TAMIS platform has also been demonstrated is several small series, and the feasibility of performing pure transanal total mesorectal excision has also been reported. Combined, n = 78 cases of transanal total mesorectal excision have been performed using TAMIS. The advantages of TAMIS-assisted transanal total mesorectal excision are discussed.
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Abstract
Transanal minimally invasive surgery (TAMIS) was introduced as an alternative to transanal endoscopic microsurgery in 2010. Over the past 4 years, considerable international experience has been gained with this approach. Most published reports focus on TAMIS for local excision of rectal neoplasia, but there are other important applications such as transanal mesorectal excision for rectal cancer. This comprehensive review details the progress with TAMIS since its inception. Robotic transanal surgery is a natural evolution of TAMIS still in its early infancy, which is also reviewed. A comprehensive search of PubMed, EMBASE, the Cochrane Library, and Web of Knowledge was performed. Since the inception of TAMIS in 2009, 33 retrospective studies and case reports, and 3 abstracts have been published on TAMIS for local excision of rectal neoplasms, which represents a combined n = 390 TAMIS procedures performed worldwide using eight different types of TAMIS platforms. A total of 152 lesions were excised for benign disease including adenomas and high-grade dysplasias (39 %), 209 for malignancy for carcinomas in situ and adenocarcinomas (53.5 %). Twenty-nine (7.5 %) of TAMIS resections were for other pathology, of which the majority (23/29) were neuroendocrine lesions. The remaining resections were for mucocele, gastrointestinal stromal tumor, melanoma, and fibrosis. Robotic-TAMIS has also been reported, however, data are extremely limited as there are only 7 case reports (combined n = 11) in the published literature. Success with Robotic-TAMIS has been demonstrated with various patient positions and by use of a special glove port. Transanal total mesorectal excision using the TAMIS platform has also been demonstrated is several small series, and the feasibility of performing pure transanal total mesorectal excision has also been reported. Combined, n = 78 cases of transanal total mesorectal excision have been performed using TAMIS. The advantages of TAMIS-assisted transanal total mesorectal excision are discussed.
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16
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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 2014; 29:605-10. [PMID: 24676506 DOI: 10.1007/s00384-014-1849-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/09/2014] [Indexed: 02/04/2023]
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. 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 <euro> ± 440 for TEO and 2,603 <euro> ± 507 for TEM (95% CI 218.15-926.486 <euro>, 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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17
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Escisión total del mesorrecto por vía transanal. Cir Esp 2014; 92:221-2. [DOI: 10.1016/j.ciresp.2014.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2013] [Revised: 12/26/2013] [Accepted: 01/09/2014] [Indexed: 11/24/2022]
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Smart CJ, Cunningham C, Bach SP. Transanal endoscopic microsurgery. Best Pract Res Clin Gastroenterol 2014; 28:143-57. [PMID: 24485262 DOI: 10.1016/j.bpg.2013.11.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Revised: 09/14/2013] [Accepted: 11/23/2013] [Indexed: 02/07/2023]
Abstract
Transanal endoscopic microsurgery (TEMS) is a well established method of accurate resection of specimens from the rectum under binocular vision. This review examines its role in the treatment of benign conditions of the rectum and the evidence to support its use and compliment existing endoscopic treatments. The evolution of TEMS in early rectal cancer and the concepts and outcomes of how it has been utilised to treat patients so far are presented. The bespoke nature of early rectal cancer treatment is changing the standard algorithms of rectal cancer care. The future of TEMS in the organ preserving treatment of early rectal cancer is discussed and how as clinicians we are able to select the correct patients for neoadjuvant or radical treatments accurately. The role of radiotherapy and outcomes from combination treatment using TEMS are presented with suggestions for areas of future research.
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Affiliation(s)
- Christopher J Smart
- School of Cancer Studies, Academic Department of Surgery, Room 28, 4th Floor,Queen Elizabeth Hospital Edgbaston, Birmingham B15 2TH, UK.
| | - Chris Cunningham
- Oxford University Hospitals NHS Trust, John Radcliffe Hospital, Headley Way, Headington, England OX3 9DU, UK.
| | - Simon P Bach
- School of Cancer Studies, Academic Department of Surgery, Room 28, 4th Floor,Queen Elizabeth Hospital Edgbaston, Birmingham B15 2TH, UK.
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Hershman MJ, Mohammad H, Hussain A, Ahmed A. Local excision of rectal tumours by minimally invasive transanal surgery. Br J Hosp Med (Lond) 2013; 74:387-90. [PMID: 24159640 DOI: 10.12968/hmed.2013.74.7.387] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Affiliation(s)
- Michael J Hershman
- Department of Colorectal Surgery, Mid Staffordshire NHS Foundation Trust, Stafford ST16 3SA.
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Atypical indications for transanal endoscopic microsurgery to avoid major surgery. Tech Coloproctol 2013; 18:157-64. [PMID: 23813055 DOI: 10.1007/s10151-013-1040-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2013] [Accepted: 06/02/2013] [Indexed: 12/16/2022]
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.
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Abstract
OBJECTIVE To evaluate the feasibility of transanal single port surgery in 15 consecutive patients. BACKGROUND The current method of choice for local resection of rectal tumors is transanal endoscopic microsurgery (TEM), a complex and expensive technique. Single access surgery is easy, relatively cheap, and more broadly applied in laparoscopy. Evidence regarding transanal use of single access ports is scarce. METHODS Consecutive patients with a rectal lesion otherwise eligible for TEM were operated using the Single Site Laparoscopic Access System (SSL) and standard laparoscopic instrumentation. Patient, lesion and procedure characteristics, hospitalization length, and peroperative and postoperative complications were recorded. RESULTS Fifteen patients were planned for single port transanal surgery. In 2 patients (13.3%), intrarectal retractor expansion failed, and conversion to conventional TEM was necessary. The remaining 13 patients were successfully operated. Rectal lesions (mean diameter 36 mm, standard deviation ±25 mm, mean distance from the dentate line 6 cm [±4.5]) included adenoma in 7 patients, T1 adenocarcinoma in 1, T2 adenocarcinoma in 3, carcinoid in 1, and fibrosis only in 1 (after prior polypectomy). All patients were operated in lithotomy position. Resections were en bloc, full thickness, and had complete margins. Resection specimens measured 65 (±35) × 52 (±24) mm. Twelve rectal defects were sutured. One peroperative pneumoscrotum occurred. Mean operating time was 57 (±39) minutes. One patient presented with postoperative hemorrhage, treated conservatively (postoperative morbidity rate 7.7%). Mean hospitalization lasted 2.5 days (±2.7). CONCLUSIONS Transanal single port surgery via the SSL is feasible and safe and may become a promising alternative to TEM.
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Serra-Aracil X, Alcántara M, Corredera C, Mora L, Navarro S. [Rectal prolapse repair using transanal endoscopic surgery]. Cir Esp 2012; 90:525-8. [PMID: 22854204 DOI: 10.1016/j.ciresp.2012.05.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2012] [Revised: 05/12/2012] [Accepted: 05/19/2012] [Indexed: 01/19/2023]
Abstract
Rectal prolapse repair techniques using laparoscopic abdominal surgery are the treatments of choice. However, in patients with increased morbidity, perineal surgical techniques are indicated. Transanal endoscopic surgery is presented as a possible alternative option in groups with increased experience in it.
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Affiliation(s)
- Xavier Serra-Aracil
- Unidad de Coloproctología, Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Parc Tauli, Sabadell, Barcelona.
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Barendse RM, van den Broek FJC, van Schooten J, Bemelman WA, Fockens P, de Graaf EJR, Dekker E. Endoscopic mucosal resection vs transanal endoscopic microsurgery for the treatment of large rectal adenomas. Colorectal Dis 2012; 14:e191-6. [PMID: 22023493 DOI: 10.1111/j.1463-1318.2011.02863.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
AIM Large (> 2 cm) rectal adenomas are currently treated by transanal endoscopic microsurgery (TEM) or piecemeal endoscopic mucosal resection (EMR). The potential lower morbidity of EMR becomes irrelevant if it is less effective. We aimed to compare the safety and effectiveness of EMR and TEM for large rectal adenomas. METHOD Data from patients undergoing TEM or EMR for a rectal adenoma > 2 cm in eight hospitals were retrospectively collected. Patient- and procedure-related characteristics, complications and recurrences were recorded. As EMR may require several attempts to achieve complete resection, early (after a single intervention) and late (permitting re-treatment for residual adenoma within 6 months) recurrence rates were determined. RESULTS Two hundred and ninety-two (292) patients (49% male; mean age 67 years) were included; 219 were treated by TEM and 73 by EMR. Adenomas treated by EMR were smaller (median 30 vs 40 mm; P = 0.007). Perioperative complication rates were 2% for TEM and 6% for EMR (P = 0.171). Postoperative complications occurred in 24% of TEM patients and in 13% of EMR patients (P = 0.038). Median hospitalization after TEM was 3 days vs 0 days after EMR (P < 0.001). Median follow-up was 12.6 months (0-47 months); Early recurrence rates were 10.2% in TEM patients and 31.0% in EMR patients (P < 0.001); late recurrence rates were 9.6% and 13.8%, respectively (P = 0.386). CONCLUSION After a single intervention, EMR of large rectal adenomas seems less effective, but safer than TEM. When allowing re-treatment of residual adenoma within 6 months, EMR and TEM seem equally effective. A prospective randomized comparison seems to be necessary.
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Affiliation(s)
- R M Barendse
- Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, the Netherlands.
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Asencio Arana F, Uribe Quintana N, Balciscueta Coltell Z, Rueda Alcárcel C, Ortiz Tarín I. Cirugía endoscópica transanal con material convencional de laparoscopia, ¿es factible? Cir Esp 2011; 89:101-5. [DOI: 10.1016/j.ciresp.2010.11.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2010] [Revised: 10/17/2010] [Accepted: 11/01/2010] [Indexed: 01/15/2023]
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Asencio Arana F, Uribe Quintana N, Balciscueta Coltell Z, Rueda Alcárcel C, Ortiz Tarín I. Transanal endoscopic surgery with conventional laparoscopy materials: Is it feasible? ACTA ACUST UNITED AC 2011. [DOI: 10.1016/s2173-5077(11)70015-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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