Feasibility of radical sigmoid colectomy performed as natural orifice translumenal endoscopic surgery (NOTES) using transanal endoscopic microsurgery

Whiteford, Mark H.; Denk, Peter M.; Swanström, Lee L.

doi:10.1007/s00464-007-9552-x

Cited by 252 publications

(171 citation statements)

References 12 publications

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“…There are serious concerns that the conclusions of the published articles on TAMIS as a valid alternative to TEM are too optimistic. In fact, 30 years after its introduction into the clinical setting, TEM is not only the standard surgical treatment for benign polyps and early cancers of the rectum, it has also demonstrated several other features such as efficacy in achieving endoluminal circumferential resections up to complete colorectal procedures [19]. Until clinical trials on the topic are available and the safety of TAMIS is confirmed, TEM remains an unequaled tool for rectal surgeons.…”

Section: Discussionmentioning

confidence: 99%

TransAnal Minimally Invasive Surgery (TAMIS) with SILS™ Port versus Transanal Endoscopic Microsurgery (TEM): a comparative experimental study

Rimonda¹,

Arezzo

Arolfo

et al. 2013

Surg Endosc

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The definitive version is available at: La versione definitiva è disponibile alla URL: http://link.springer.com/article/10.1007%2Fs00464-013-2962 Since clinical application has begun in the absence of any experimental validation, we assessed its feasibility and efficacy ex vivo in a pilot study. Methods In a dedicated trainer box for transanal procedures, 10 surgeons with no experience in transanal surgery were asked to perform a dissection/suture task using both TAMIS and TEM in randomly allocated order. Surgeons were asked to dissect two identically drawn lesions of ~3 cm in larger diameter. Precision of dissection was assessed using a quantitative photographic method, while the time needed for dissection and suturing was considered a measure of quantitative evaluation. Each participant expressed a subjective opinion regarding difficulty with dissection, difficulty with suturing, vision quality, and conflict between instruments on a scale from 1 to 5. ResultsNo difference was observed between the two techniques regarding the accuracy of dissection as the margin was interrupted along 4.1 % of the circumference in the TEM group compared with 2.48 % in the SILS group (P = 0.271). Dissection and suturing were significantly quicker in the TEM group [04:30 vs. 06:35 min (P = 0.049) and 14:34 versus 19:18 min (P = 0.003)]. In three cases in the SILS group, completing the suture was not considered possible, and the procedures were terminated by TEM. Subjective evaluation revealed a better appreciation of TEM in all proposed comparisons: dissection (2.6 vs. 3.5, P = 0.004), suturing difficulty (3.1 vs. 4.6, P < 0.001), quality of vision (2.3 vs. 2.8, P = 0.18), and instrument conflicts (3.1 vs. 4.0, P = 0.054). Conclusions In the ex vivo setting, both techniques were comparable for achieving a good dissection, although TAMIS failed to prove effective in suturing the rectal wall. Moreover, TEM was significantly quicker despite the small groups and was better appreciated by the surgeons.

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Section: Discussionmentioning

confidence: 99%

TransAnal Minimally Invasive Surgery (TAMIS) with SILS™ Port versus Transanal Endoscopic Microsurgery (TEM): a comparative experimental study

Rimonda¹,

Arezzo

Arolfo

et al. 2013

Surg Endosc

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“…It immediately set off a worldwide quest to determine what types of operations could be mastered with the NOTES approach. Among these leaders was Mark Whiteford, who in collaboration with NOTES authority, Lee Swanström, successfully demonstrated that transanal TME could be completed using a TEM scope and without abdominal assistance in a cadaveric model [7]. Unlike Marks, Whiteford's objective was not improved access to the distal rectum, but rather the avoidance of abdominal access trauma (the very impetus behind NOTES) [6].…”

mentioning

confidence: 99%

Transanal total mesorectal excision: full steam ahead

Atallah¹

2015

Tech Coloproctol

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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,...

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“…Так, в 2007 г. M. Whiteford [33] сообщил о первой трансанальной резекции прямой кишки посред-ством использования платформы ТЭМ на трупах. Следующим этапом стало экспериментальное при-менение трансанальных резекций на животных [34].…”

Section: обзорыunclassified

Current methods in the treatment of rectal cancer

Kazieva¹,

Рыбаков²,

Sevostianov³

2016

Endosk. khir.

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Feasibility of radical sigmoid colectomy performed as natural orifice translumenal endoscopic surgery (NOTES) using transanal endoscopic microsurgery

Abstract: It is possible to complete the critical steps of a NOTES sigmoid resection, en bloc lymphadenectomy, primary anastomosis, and retrieval of an intact specimen without any incisions using transanal endoscopic microsurgery instrumentation.

Cited by 252 publications

References 12 publications

TransAnal Minimally Invasive Surgery (TAMIS) with SILS™ Port versus Transanal Endoscopic Microsurgery (TEM): a comparative experimental study

TransAnal Minimally Invasive Surgery (TAMIS) with SILS™ Port versus Transanal Endoscopic Microsurgery (TEM): a comparative experimental study

Transanal total mesorectal excision: full steam ahead

Current methods in the treatment of rectal cancer

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