Combining ultrasonic dissection and the Storz operation rectoscope

Abstract

For tumors located up to 15 cm from the anal verge, TEM with the Storz rectoscope and ultrasonic dissection is indicated. Despite the complication described, coagulation is optimal and ultrasonic scissors allow working in a fairly bloodless field. The overall costs of the equipment are significantly lower.

Transanal endoscopic operation for rectal lesions using two-dimensional visualization and standard endoscopic instruments: a prospective cohort study and comparison with the literature

“…In 2006, a prospective study by Maslekar et al [15] showed that transanal endoscopic surgery is cost effective compared with open resection of early rectal cancer [13,19]. The use of standard laparoscopic equipment reduces the costs even more because of fewer costs for the equipment than for the 3D system (€15,000 vs €44,000, excluding the value added tax (VAT)).…”

“…To our knowledge, only one prospective study, by Lirici et al [13], published in 2003, compared the 3D and 2D systems, and only in combination with the use of the ultrasonic dissection. The size of the patient population was 18, which is the number of TEOs that have been performed according to the modified technique: 9 for malignant and 9 for benign lesions.…”

“…In the study of Lirici et al [13], the operating time ranged from 30 to 360 min. The publications that included operating time showed that the 3D system required respective means of 75 min (range, 20-385 min), 91 min (range, 35-175 min), and 96 min (range, 4-235 min) compared with a mean of 55 min (range, 25-165 min) for the 2D armamentarium [7,20,22].…”

“…Standard laparoscopic grasping forceps, ultrasonic shears, and a needleholder were used. In addition, coagulation, ligasure, and ultracision were applied to control bleedings [13]. A rigid rectoscopy was performed before the operation to establish the distance of the lesion from the anal verge and its exact location on the rectal circumference.…”

Ultracision Harmonic Scalpel and multifunctional tem400 instrument complement in transanal endoscopic microsurgery: a prospective study

“…The disadvantage of this system is its limited capacity for resecting larger circumferential and more proximal tumors. These are exactly the tumors for which an extra instrument is required to complete the excision when the Wolf system is used [22]. For both systems, a UC with a longer shaft could be of great interest.…”