Feasibility of transanal minimally invasive surgery for mid-rectal lesions

Lim, Seok‐Byung; Seo, Seok-In; Lee, Jong Lyul; Kwak, Jae Young; Jang, Tae Young; Kim, Chan Wook; Yoon, Yong Sik; Yu, Chang Sik; Kim, Jin Cheon

doi:10.1007/s00464-012-2303-7

Cited by 92 publications

(62 citation statements)

References 17 publications

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“…The most critical issue is suturing. Other authors recently reported difficulties in repairing the excision defect so that different methods have been proposed, including use of an endo-GIA stapler [9], intracorporeal suture-tying [11,12], or interrupted sutures with extracorporeal knots that are secured with a knot-pusher [10]. In any case, the maneuver is very challenging and an ideal technique has not been described yet.…”

Section: Discussionmentioning

confidence: 99%

“…as TransAnal Mini-Invasive Surgery (TAMIS) [9,10], Transanal Single-Port Microsurgery (TSPM) [11], Transanal Endoscopic Video-Assisted surgery (TEVA) [12], and SILSTEM [13], has been adopted. In all these procedures, a single-incision laparoscopic surgery port is introduced into the anal canal, followed by transanal excision using standard laparoscopic instruments.…”

mentioning

confidence: 99%

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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%

mentioning

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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“…TAMIS, which was a novel approach, was first reported by Atallah et al in 2010 (13). This was followed by various reports of the use of TAMIS in an increasing number of cases, using similar platforms with acceptable outcomes (18)(19)(20)(21). TAMIS using a GelPOINT ® Path provides excellent exposure of the operative field, due to its high-definition flexible tip camera and constant gas dilatation, The depth of T1 invasion is indicated (as x µm); well, well-differentiated adenocarcinoma; mod, moderately differentiated adenocarcinoma; ly, lymphatic invasion; v, venous invasion; F, female; M, male.…”

Section: Discussionmentioning

confidence: 99%

Transanal minimally invasive surgery (TAMIS) with a GelPOINT® Path for lower rectal cancer as an alternative to transanal endoscopic microsurgery (TEM)

Noura

Ohue

Miyoshi

et al. 2016

Molecular and Clinical Oncology

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Abstract. Transanal endoscopic microsurgery (TEM) is a minimally invasive technique. However, TEMhas not yet achieved widespread use. Recently, transanal minimally invasive surgery (TAMIS) using single-port surgery devices has been reported. In the present study, TAMIS using a GelPOINT ® Path was performed in six patients with lower rectal cancer. A complete full-thickness excision was performed in all cases. The patient characteristics, operative techniques and operative outcomes were evaluated. The mean age of the patients was 63.0 years (range: 48-76). The mean operating time and blood loss were 86 min (range: 55-110) and 5 ml (range 0-10), respectively. There were no instances of morbidity or mortality. Additional transabdominal rectal resection was not performed, and adjuvant chemoradiotherapy was performed in all cases. The mean Wexner score was 0.6 (range: 0-3; n=5) at 6 months, and 0 (range: 0; n=4) at 12 months. TAMIS using a GelPOINT ® Path was revealed to be easy and safe to perform. Although only a small number of cases were treated, the anal function following surgery was shown to be favorable, and the operation was demonstrated to be sufficiently feasible. Based on these results, TAMIS may, in time, assume a major role in the resection of large adenomas and early rectal cancers. IntroductionThe rectum is a challenging area for surgeons to operate on due to its limited access. Although advances in conventional surgery have broadened the choice of sphincter-preserving procedures, definitive colostomy is still necessary in 10-30% of patients (1). Furthermore, the postoperative morbidity and mortality rates remain high (2). Besides urinary dysfunction, the disturbance of bowel function proves a major problem in ~30% of patients (3,4).Benign neoplasia and early-stage rectal cancer located in the rectum have been traditionally managed with transanal excision (TAE) using a conventional instrument, such as a Parks retractor. This approach, however, has several limitations, as exposure and visibility within the rectal lumen curtail the surgeon's ability to perform a high-quality oncological excision. Since the introduction of transanal endoscopic microsurgery (TEM), which was first described by Buess et al (5), TEM has become the treatment of choice for benign lesions and early-stage cancers that are not suited to TAE using a conventional Parks retractor or flexible endoscope (6,7). TEM has also become a valuable option in selected patients with malignant rectal disease, in whom it may provide an acceptable oncological outcome with minimal postoperative morbidity and an improved functional outcome compared with standard radical resection (8,9). However, nearly 30 years after the introduction of TEM, this transanal platform has not achieved widespread adoption due to the cost and the complexity of the instruments, the steep learning curve and the requirement of specialized training to master the operation (10,11).Although the instruments and procedures that are used in resection with TEM have remained largel...

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“…С учетом того, что способ ТЭМ успешно используется во всем мире для хирургии добро-качественных и злокачественных новообразова-ний прямой кишки, в последние годы появился повышенный интерес к применению этого способа для реверсивного выделения опухоли и прямой кишки при злокачественных новооб-разованиях с удалением макропрепарата через естественные анатомические отверстия [45,46]. Трансанальное снизу вверх выделение опухоли и прямой кишки с использованием ТЭМ имеет ряд преимуществ:…”

Section: трансанальная мезоректумэктомияunclassified

Transanal Endoscopic Microsurgery of Benign and Malignant Rectal Tumors

Жандаров¹,

Ждонец²,

Kul³

et al. 2017

Novosti Khirurgii

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Целью обзора являлось проведение анализа современной литературы для определения места транс-анальной эндоскопической микрохирургии (ТЭМ) в колопроктологии, недостатков и основных направле-ний совершенствования данной методики. Важной задачей, стоящей перед колоректальными хирургами и онкологами, является снижение травматичности операции, предупреждение осложнений и функциональ-ных нарушений после обширных оперативных вмешательств, которые в недавнем прошлом широко при-менялись в колоректальной хирургии. В настоящее время по этой причине предпочтение отдается мало-травматичным методам хирургического лечения, таким как эндоскопическая петлевая электроэксцизия, традиционное трансанальное удаление и метод трансанальной эндомикрохирургии (ТЭМ). Для каждого из них есть свои показания, и каждый из них обладает как преимуществами, так и некоторыми недостатками. В связи с высокой стоимостью полного комплекта ТЭМ данный высокопрецизионный способ лечения опухолевых образований прямой кишки до сих пор не нашел широкого применения в колопроктологии.Практически совсем недавно появились сообщения о первом опыте использования TEO, TAMIS, RTS. TEO (transanal endoscopic operation) -модифицированная система ТЕМ с оригинальной встроенной оптической системой и возможностью использования как штатных лапароскопических инструментов, так и оригинальных TAMIS (transanal minimal invasive surgery) -использование в анальном канале SILS Port, Covidien. Проведенный анализ показал, что методы ТЕМ постоянно совершенствуются и находят новые точки применения в хирургии толстого кишечника и прямой кишки. Однако некоторые технические мо-менты, такие как улучшение расправляемости прямой кишки и улучшение визуализации места оператив-ного вмешательства, требуют доработки и последующего совершенствования. Ключевые слова: трансанальная хирургия, SILS-port, опухоль прямой кишки, колопроктология, эндоскопическая петлевая электроэксцизия, традиционное трансанальное удаление, удаление опухолевых образований прямой кишкиThe objective of a literature review is to determine the place of the transanal endoscopic microsurgery (TEM) in сoloproctology, to identify disadvantages and to establish the main directions advancing this technique. An important challenge for colorectal surgeons and oncologists, is the reduction of morbidity, prevention of complications and functional disorders, faster recovery after extensive surgeries, which in the recent past were widely used in the colorectal surgery. At present for this reason preference is given to low-traumatic surgical techniques such as a loop endoscopic electrosurgical excision procedure, traditional transanal excision and method of transanal endomicrosurgery (TEM). It is clear that all methods have their advantages and disadvantages, so as the indications for each. Due to the high cost of the complete set of TEM, the given high-precision method of treating rectal tumors is still not widely used in сoloproctology. Recently there have been reports about the first experience of using TEO, TAMIS, RTS. TEO (transanal ...

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Feasibility of transanal minimally invasive surgery for mid-rectal lesions

Abstract: TAMIS seems to be a feasible and safe treatment option for lesions located in the mid rectum.

Cited by 92 publications

References 17 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 minimally invasive surgery (TAMIS) with a GelPOINT® Path for lower rectal cancer as an alternative to transanal endoscopic microsurgery (TEM)

Transanal Endoscopic Microsurgery of Benign and Malignant Rectal Tumors

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