Transanal endoscopic operation: a new proposal

Abstract

Purpose: The transanal procedure for rectal cancer surgery is one of the many techniques currently available. Different techniques for local excision of rectal tumors include: conventional transanal technique, posterior access surgery, therapeutic colonoscopy, transanal endoscopic surgery. Methods: The aim of the present study is to describe a new method of transanal endoscopic resection, transanal endoscopic operation (TEO), and performed with the aid of a surgical proctoscope especially designed for this purpose and report the results obtained in 32 patients submitted to the TEO and to compare these results with those obtained with other techniques currently available. The average proportions of recurrence, postoperation complications and posterior resections were analyzed by means of a metanalysis. Data on the distance and size of rectal lesions, the operative timing and hospitalization time were distributed in graphs according to authors and techniques. Results: The results were favorable and equivalent to those described in the literature. Conclusions: The surgical proctoscope specially designed for this study is efficient and has a low cost; the TEO is easily performed with the aid of this equipment; the final results were favorable and similar to those obtained with other available techniques for endoscopic transanal intestinal resection, which are of high cost and less availability.Key words: Rectal Surgery. Endoscopy. RESUMOIntrodução: A operação cirúrgica por acesso transanal no tratamento do câncer retal é uma das várias técnicas utilizadas nessa terapêutica. Há várias técnicas de excisão local para os tumores retais: O método cirúrgico transanal convencional, acessos posteriores, colonoscopia terapêutica e operações transanais endoscópicas. O objetivo é apresentar um novo método de ressecção transanal endoscópica (Operação Transanal Endoscópica -OTE), realizada com um proctoscópio cirúrgico idealizado para o procedimento e divulgar os resultados obtidos em 32 pacientes submetidos a OTE e compará-los com as técnicas atualmente empregadas. Métodos: Foram analisadas as proporções médias da recorrência, das complicações pós-operatórias e das ressecções posteriores por meio da técnica de metanálise. Para a distância e o tamanho das lesões retais, os tempos de operação e de hospitalização, foram feitos gráficos de acordo com o autor e a técnica. Resultados: Os resultados foram favoráveis e equiparáveis aos trabalhos analisados. Conclusão: Concluiu-se que: O proctoscópio utilizado na OTE demonstrou ser eficaz e de baixo custo; 2 -A OTE mostrou-se factível; 3 -A análise dos resultados com a OTE foram satisfatórios e similares às outras técnicas de ressecções transanais endoscópicas que são de alto custo e pouco disponíveis em nosso meio.Descritores: Cirurgia Retal. Endoscopia. Rocha JJR et al 94

Surgical and postoperative evaluations of rectal adenomas excised with a rigid proctoscope

“…The initial cost of specialized TEM equipment is perceived by some surgeons as a limiting factor for the widespread adoption of this technique 23 . The proctoscope used in this study is cheap (approximately U$ 300), and conventional and laparoscopic surgical instruments can be used without the need for gas insufflation, providing a three-dimensional view and allowing greater accessibility for surgeons 10,11,24 .…”

“…Surgical proctoscopes were devised and constructed at HCFMRP-USP and were previously described in 2008 10,11 . The proctoscopes are made of stainless steel and resemble a cylinder.…”

Transanal minimally invasive surgery with single-port (TAMIS) for the management of rectal neoplasms: a pilot study

“…TAMIS is not the first modification of the TEM method. Other apparatus as TEO, using 2D optical systems, in contrast to the three-dimensional view of TEM, are also used with similar results to TEM 23 . Based on reports in the literature, we could identify more than 70 patients treated by TAMIS (Table 1), with results comparable to those of TEM for negative margins, conversion and complication rates.…”

Management of the main postoperative surgical complications after transanal endoscopic microsurgery: an observational study

“…Later technical variations on TEM include transanal endoscopic operation (TEO) [2] , which uses a high definition monitor, and TAMIS [3] (TransAnal Minimally Invasive Surgery), a more recent development that incorporates a single-port system. The application of strict selection criteria and careful surgical techniques obtain good results for postoperative morbidity and mortality, function, and cure.…”