Efficiency and outcomes of harmonic device in transanal endoscopic microsurgery compared with monopolar scalpel

Abstract

Harmonic scalpel provides a safer, easier, and more precise surgical section through clean, bloodless, and better visualized operative field. The additional cost of UC was compensated with the decrease in the health resources (mainly hospital stay).

Eight Years Experience of Transanal Endoscopic Microsurgery

“…We also did not find reduced complication with use of harmonic as other studies were found. 3 Closing lumen defect above peritoneal reflection is mandatory but It is optional to suture the rectal defect after resection of lesions below the reflection and it is assumed that closing the defect is associated with better hemostasis, improved healing and reduced risk of stricture. Meta-analysis of studies showed that closing the rectal defect is only improve bleeding control and leaving the defect open is not associated with infection, hospital stay or reduced time of surgery.…”

“…2 Because of its low complication rate TEM is considered as gold standard modality for local transanal operations and new armaments are added to its capabilities. 3…”

“…As TEM experience grows colorectal centers publish their experience regarding operation technique, 4 devices that used, 3 efficacy and complications. 5 although these studies have some suggestions for application of TEM but all of them suggest further studies with larger sample size and longer follow-up period.…”

Transanal Endoscopic Microsurgery (TEM) Facilitated by Video‐Assistance and Anal Insertion of a Single‐Incision Laparoscopic Surgery (SILS®)‐Port: Preliminary Experience

“…Because this equipment and the instruments are the same as in conventional laparoscopy or thoracoscopy, surgeons adopting the SILS ® ‐TEM technique will be familiar with these devices from the very beginning, with a shorter learning curve and a better and faster adoption of the SILS ® ‐TEM technique. For resection, e.g., we also used the harmonic scalpel occasionally, as shorter operation times and fewer bleeding complications have been described [27, 28]. Indeed, we soon stopped using the harmonic scalpel as we did not see any advantage and the use of it has been described to result in oblique and conical instead of cylindrical specimen resection [10].…”

Transanal full-thickness excision for rectal neoplasm: is it advisable to leave the defect open?

“…Full-thickness excision was performed for all rectal tumors. In 2005, as an improvement of the existing technique [ 1 , 3 ], an ultrasonic scalpel device from Ethicon (New Jersey, USA) was used [ 12 ]. During the early years of TEM at our institution, suturing the defect was the treatment of choice; however, using the results of our randomized study [ 8 ], this step was no longer routinely performed, and the decision was based on the surgeon’s preference.…”