AirSeal system insufflator to maintain a stable pneumorectum during TAMIS

Bislenghi, Gabriele; Wolthuis, A.; Overstraeten, Anthony de Buck van; D’Hoore, André

doi:10.1007/s10151-014-1244-7

Cited by 45 publications

(18 citation statements)

References 10 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Three working ports are placed into the GelCap: 2 regular ports, including a camera port, are inserted at the 11 o'clock and at the 6 o'clock positions, and 1 AirSeal port is inserted at the 2 o'clock position. 12 The GelCap is then mounted onto the platform. Pneumorectum is achieved at a pressure of 15 mm Hg with carbon dioxide gas.…”

Section: Surgical Techniquementioning

confidence: 99%

Transanal minimally invasive surgery for benign large rectal polyps and early malignant rectal cancers: experience and outcomes from the first Canadian centre to adopt the technique

Caycedo‐Marulanda

Jiang

Kohtakangas

2017

CJS

View full text Add to dashboard Cite

Background: Transanal minimally invasive surgery (TAMIS) has emerged as a relatively new technique in treating early cancer and benign lesion of the rectum. The technique is likely to be widely adopted, surpassing other comparable techniques owing to its simple setup and costeffectiveness. We assessed the outcomes of TAMIS at our centre. Methods:We retrospectively reviewed prospectively collected data on 50 patients who underwent TAMIS for benign, malignant T1 or T2 cancers that were unfit for radical surgery over a 4-year period. Outcomes, including 30-day complications and recurrence, as well as our ability to implement and integrate this technique at our centre were assessed.Results: All 50 TAMIS procedures were successful. The average lesion was 7 cm from the anal verge, the average tumour size was 2.5 cm, the average duration of surgery was 73 minutes, the average length of stay was 1.1 days, and the margin negativity was 84%. Major indications in our series included 25 lesions that were too large for endoscopic resection, 14 early cancers or high-grade dysplasia, 10 margin checks postpolypectomy, 6 cases of recurrent polyposis, and 4 medically unfit patients. There were no deaths. The rate of short-term complications, including rectal bleeding, reoperation and urinary retention, was 16%. The rate of long-term complications, including anal incontinence and stenosis, was 4%. Benign and malignant recurrence rates were 2% and 6%, respectively. Overall long-term requirement for invasive procedures, low anterior resection or abdominoperineal resection, was 12%. Conclusion:To our knowledge, this is the first Canadian study showing TAMIS to be an efficient and safe procedure for the treatment of well-selected patients with rectal lesions. Outcomes from our centre are comparable with those found in the literature.Contexte : La chirurgie transanale mini-invasive (TAMIS) s'est imposée comme une technique relativement nouvelle pour le traitement du cancer précoce et des lésions bénignes du rectum. La technique est en voie d'être adoptée à grande échelle, voire de supplanter d'autres techniques comparables, en raison de sa mise en place facile et de sa rentabilité. Nous avons évalué les résultats de la technique TAMIS dans notre centre.Méthodes : Nous avons fait une analyse rétrospective de données recueillies de façon prospective sur 50 patients traités par TAMIS pour cause de cancer T1 ou T2 malin ou bénin et non candidats à la chirurgie radicale, sur une période de 4 ans. Nous avons évalué les résultats, y compris les complications et la récidive sur 30 jours, ainsi que notre capacité d'adopter et d'intégrer cette technique dans notre centre. Résultats :Les 50 chirurgies TAMIS furent une réussite. La taille moyenne de la lésion était de 7 cm à partir de la marge anale, la taille moyenne de la tumeur était de 2,5 cm, la durée moyenne de la chirurgie était de 73 minutes, la durée moyenne d'hospitalisation était de 1,1 jour et le taux de marges négatives était de 84 %. Parmi les principales indications dans notre série...

show abstract

Section: Surgical Techniquementioning

confidence: 99%

Transanal minimally invasive surgery for benign large rectal polyps and early malignant rectal cancers: experience and outcomes from the first Canadian centre to adopt the technique

Caycedo‐Marulanda

Jiang

Kohtakangas

2017

CJS

View full text Add to dashboard Cite

show abstract

“…Recently, a durable and simple solution has been realized-and that is use of a valveless trocar system [21]. Such a trocar is easily adaptable to the existing TAMIS platform and resolves the bellowing and excess smoke buildup due to its triple lumen system that provides independent regulation of (a) insufflation pressure, (b) CO 2 delivery, and (c) smoke evacuation.…”

mentioning

confidence: 99%

Transanal total mesorectal excision: full steam ahead

Atallah¹

2015

Tech Coloproctol

View full text Add to dashboard Cite

The article by Araujo [1] in this month's issue documents the dramatic climb of transanal total mesorectal excision (transanal TME) with the most comprehensive review on this topic to date and a revelation of published numbers that are approximately double what they were just 1 year ago [2]. While it may seem as if transanal TME materialized overnight, in actuality, its foundation had been quietly in development for three decades. The seeming sudden ascent of transanal TME is analogous to a building under construction. Developing a proper foundation is a time-intensive and critical first step. To naïve observers of a construction site, it may appear as though no progress is underway, until the foundation is completed and suddenly a building begins to rise ten stories high, filling in the skyline with striking speed.The foundation for transanal TME began 30 years ago with the innovative efforts of Gerald Marks and later carried on with his son John Marks. In the early 1980s, G. Marks pioneered the technique of what he termed the transabdominal-transanal (TATA) operation for rectal cancers involving the distal one-third of the rectum [3], performing a meticulous dissection from below and adapting Bill Heald's concept of TME, albeit 'in reverse.' This predated the era of laparoscopy and the first TATA operations were completed with an open approach before transitioning to the use of laparoscopic assistance in the 1990s [4]. For 30 years, Marks' TATA operation laid down the foundation for modern transanal TME, spelling out very clearly why this approach was preferred for distal rectal cancer. Principally, the advantages of TATA were (a) definition of the distal margin from below, thereby assuring no tumor involvement at the line of distal division and (b) obviating the need for stapling devices for transection, which do not comply with boney constraints ofin particular-the narrow male pelvis. Even when staplers could be negotiated into pelvic confines from above, there was still the risk of inadvertently stapling across tumor, thereby irreversibly compromising the oncologic integrity of the operation. While Marks' rationale behind TATA was perfectly on point, the technique required specialized retractors with limited exposure, and thus few were able to replicate this approach.In parallel with TATA, the transanal endoscopic microsurgery (TEM) scope was developed by Buess [5] and considerable experience was gained with TEM for local excision of rectal neoplasia, though primarily for nonmalignant lesions. TEM was, for many, an unaffordable privilege of the elite; most colorectal surgeons, to this day, are not privy to TEM nor have they had formal training with this exquisite device. TEM's penetration had remained limited due to prohibitive upfront costs and also the complexity it mandates from surgeons.During a recent lectureship webcast, a renowned colorectal surgeon remarked that, 'in [the year] 2000, TEM was dead.' This statement was not intended to discredit the otherwise precocious TEM marvel. Implicit, however,...

show abstract

“…This tendency can be offset by suture closure of the defect around the device once in situ or, more usefully, by use of an advanced sufflation system such as the AirSeal that can provide variable flow to ensure stability of distension volume despite the open circuit effect of incomplete gas sealing. [18]…”

Section: Discussionmentioning

confidence: 99%

Abdomino-endoscopic perineal excision of the rectum for benign and malignant pathology: Technique considerations for true transperineal verus transanal total mesorectal excision endoscopic proctectomy

Furajii

Kennedy

2017

J Min Access Surg

View full text Add to dashboard Cite

PURPOSE:Transanal minimally invasive surgery using single port instrumentation is now well described for the performance of total mesorectal excision with restorative colorectal/anal anastomosis most-often in conjunction with transabdominal multiport assistance. While non-restorative abdomino-endoscopic perineal excision of the anorectum is conceptually similar, it has been less detailed in the literature.METHODS:Consecutive patients undergoing non-restorative ano-proctectomy including a transperineal endoscopic component were analysed. All cases commenced laparoscopically with initial medial to lateral mobilisation of any left colon and upper rectum. The lower anorectal dissection started via an intersphincteric or extrasphincteric incision for benign and malignant pathology, respectively, and following suture closure and circumferential mobilisation of the anorectum, a single port (GelPOINT Path, Applied Medical) was positioned allowing the procedure progress endoscopically in all quadrants up to the cephalad dissection level. Standard laparoscopic instrumentation was used. Specimens were removed perineally.RESULTS:Of the 13 patients (median age 55 years, median BMI 28.75 kg/m2, median follow-up 17 months, 6 males), ten needed completion proctectomy for ulcerative colitis following prior total colectomy (three with concomitant parastomal hernia repair) while three required abdominoperineal resection for locally advanced rectal cancer following neoadjuvant chemoradiotherapy. Median operative time was 190 min, median post-operative discharge day was 7. Eleven specimens were of high quality. Four patients developed perineal wound complications (one chronic sinus, two abscesses needing drainage) within median 17-month follow-up.CONCLUSION:Convergence of transabdominal and transanal technology and technique allows accuracy in combination operative performance. Nuanced appreciation of transperineal operative access should allow specified standardisation and innovation.

show abstract

AirSeal system insufflator to maintain a stable pneumorectum during TAMIS

Cited by 45 publications

References 10 publications

Transanal minimally invasive surgery for benign large rectal polyps and early malignant rectal cancers: experience and outcomes from the first Canadian centre to adopt the technique

Transanal minimally invasive surgery for benign large rectal polyps and early malignant rectal cancers: experience and outcomes from the first Canadian centre to adopt the technique

Transanal total mesorectal excision: full steam ahead

Abdomino-endoscopic perineal excision of the rectum for benign and malignant pathology: Technique considerations for true transperineal verus transanal total mesorectal excision endoscopic proctectomy

Contact Info

Product

Resources

About