The implementation of a transanal endoscopic microsurgery programme: initial experience with surgical performance

Helewa, Ramzi M.; Rajaee, AM; Raiche, Isabelle; Williams, Lara; Paquin‐Gobeil, Melanie; Boushey, Robin P.; Moloo, Husein

doi:10.1111/codi.13333

Cited by 20 publications

(9 citation statements)

References 30 publications

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“…The introduction of the single use TAMIS platforms has facilitated the implementation of minimally invasive techniques for transanal excision in many surgeons’ practices . However, the procedure can be technically challenging to learn, and even skilled laparoscopic surgeons require experience with many procedures to attain technical competence . The option of leaving a rectal defect unsutured is appealing early in the learning curve when operative times may be long.…”

Section: Discussionmentioning

confidence: 99%

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A multi‐centre randomized controlled trial of open vs closed management of the rectal defect after transanal endoscopic microsurgery

et al. 2019

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Aim Transanal endoscopic microsurgery (TEM) is a technically challenging strategy that allows expanded indications for local excision of rectal lesions. Transluminal suturing is difficult, so open management of the resultant defect is appealing. Expert opinion suggests there is more pain when the defect is left open. The aim of this study was to determine if closure of the defect created during full thickness excision of rectal lesions with TEM leads to less postoperative pain compared to leaving the defect open.

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Section: Discussionmentioning

confidence: 99%

“…The learning curve is still an obstacle to integrating this procedure into surgeons’ repertoire . Endoluminal suturing is particularly difficult and inability to suture through transanal platforms has been a barrier to technique adoption.…”

Section: Introductionmentioning

confidence: 99%

A multi‐centre randomized controlled trial of open vs closed management of the rectal defect after transanal endoscopic microsurgery

et al. 2019

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“…The TEM rectoscope is an expensive technology for a hospital not already using it for colorectal operations. Additionally, there is a surgical learning curve is estimated between 14 and 24 cases (11,12). …”

Section: Discussionmentioning

confidence: 99%

Use of rectal mucosal grafts in substitution urethroplasty: an early series

Monn

Waters

Mellon

2018

Transl. Androl. Urol

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BackgroundTo evaluate the feasibility of use of rectal mucosal grafts for augmentation urethroplasty.MethodsA series of five patients who underwent rectal mucosal graft urethroplasty for urethral stricture disease were identified. Descriptive statistics were used to describe these patients. Primary endpoints were recurrence of stricture and perioperative morbidity.ResultsFive patients underwent rectal mucosal graft augmentation urethroplasty. Four had a history of prior buccal mucosal graft (BMG) urethroplasty and one had a history of head and neck cancer. Rectal mucosa was noted to be thinner and required more tailoring than buccal mucosa. All patients had patent urethras at time of postoperative retrograde urethrogram. A small diverticulum was noted in one patient with no further sequelae. No complications from rectal mucosal graft harvest were noted. All patients with prior buccal grafting subjectively preferred the rectal graft due to fewer side effects. Subjectively, patients with prior buccal grafts preferred the post-operative recovery following rectal mucosal graft urethroplasty.ConclusionsRectal mucosal graft augmentation urethroplasty is a safe alternative in patients with contraindications to buccal grafting with limited morbidity.

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“…Helewa et al report a leveling of the learning curve measured by the time of operation of 16 cases, with a second plateau at 35 cases. 15 Barendse et al showed a learning curve effect on conversion to laparoscopy, procedure length, and complication rate that all decreased with increasing experience. 16 Learning curve data on this technique is difficult to interpret as many surgeons will expand indications to include more proximal or larger lesions which in turn increases operating times.…”

Section: Transanal Endoscopic Surgery Educationmentioning

confidence: 99%

Current Challenges for Education and Training in Transanal Surgery

Costedio

2021

Clin Colon Rectal Surg

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Transanal endoscopic microsurgery (TEM) is a technique that was introduced in the 1980s for improved exposure to upper rectal polyps. This technique, though initially difficult to master due to new skill acquisition for surgeons, has spared many patients proctectomy. There are many benign indications for transanal endoscopic surgery which has led to in vivo operating room training with fewer undesirable effects to the patient. With the explosion of laparoscopic technology this transanal technique is no longer limited to intraluminal pathology, but is now being used to remove the entire rectum. In transanal total mesorectal excision (taTME), benign indications are less common, translating to potentially more severe oncologic patient consequences during the early phase of adoption. For this reason, strict training criteria consensus guidelines have been developed by the experts in taTME. The current consensus statements agree that training surgeons should have performed a minimum of 10 laparoscopic TME procedures and should have some experience with transanal surgery. Surgeons need to attend a formal training course and should start clinically on benign or early malignant pathology without threated circumferential resection margins. Surgeons also need to have their first cases proctored until deemed proficient by the proctor and monitor their morbidity, oncologic, and functional outcomes prospectively.

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The implementation of a transanal endoscopic microsurgery programme: initial experience with surgical performance

Abstract: Operative efficiency appears to improve as surgeons completed 16 TEM cases. We have identified important factors that result in longer operating time. The study has important implications with regard to surgical training and operative planning for new TEM programmes.

Cited by 20 publications

References 30 publications

A multi‐centre randomized controlled trial of open vs closed management of the rectal defect after transanal endoscopic microsurgery

A multi‐centre randomized controlled trial of open vs closed management of the rectal defect after transanal endoscopic microsurgery

Use of rectal mucosal grafts in substitution urethroplasty: an early series

Current Challenges for Education and Training in Transanal Surgery

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