Transanal minimal invasive surgery for rectal lesions: should the defect be closed?

Hahnloser, Dieter; Cantero, Ramón; Salgado, Gervasio; Dindo, Daniel; Rega, Daniela; Delrio, Paolo

doi:10.1111/codi.12866

Cited by 94 publications

(66 citation statements)

References 29 publications

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“…Overall, we did not find any anorectal malfunctions due to this type of closure, nor did we find any significant difference in postoperative outcomes. A series by Hahnloser and colleagues 16 showed the rectal defect can be left open without increasing complications or compromising rectal continence. 16 Haugvik and colleagues 17 left the rectal defect open in 25% of their cases and did not find any increase in surgical morbidity.…”

Section: Discussionmentioning

confidence: 99%

“…A series by Hahnloser and colleagues 16 showed the rectal defect can be left open without increasing complications or compromising rectal continence. 16 Haugvik and colleagues 17 left the rectal defect open in 25% of their cases and did not find any increase in surgical morbidity. These studies will likely help guide practice when the lesion is too close to sphincters and too technically difficult to close.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Transanal minimally invasive surgery for benign large rectal polyps and early malignant rectal cancers: experience and outcomes from the first Canadian centre to adopt the technique

Caycedo‐Marulanda

Jiang

Kohtakangas

2017

CJS

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Background: Transanal minimally invasive surgery (TAMIS) has emerged as a relatively new technique in treating early cancer and benign lesion of the rectum. The technique is likely to be widely adopted, surpassing other comparable techniques owing to its simple setup and costeffectiveness. We assessed the outcomes of TAMIS at our centre. Methods:We retrospectively reviewed prospectively collected data on 50 patients who underwent TAMIS for benign, malignant T1 or T2 cancers that were unfit for radical surgery over a 4-year period. Outcomes, including 30-day complications and recurrence, as well as our ability to implement and integrate this technique at our centre were assessed.Results: All 50 TAMIS procedures were successful. The average lesion was 7 cm from the anal verge, the average tumour size was 2.5 cm, the average duration of surgery was 73 minutes, the average length of stay was 1.1 days, and the margin negativity was 84%. Major indications in our series included 25 lesions that were too large for endoscopic resection, 14 early cancers or high-grade dysplasia, 10 margin checks postpolypectomy, 6 cases of recurrent polyposis, and 4 medically unfit patients. There were no deaths. The rate of short-term complications, including rectal bleeding, reoperation and urinary retention, was 16%. The rate of long-term complications, including anal incontinence and stenosis, was 4%. Benign and malignant recurrence rates were 2% and 6%, respectively. Overall long-term requirement for invasive procedures, low anterior resection or abdominoperineal resection, was 12%. Conclusion:To our knowledge, this is the first Canadian study showing TAMIS to be an efficient and safe procedure for the treatment of well-selected patients with rectal lesions. Outcomes from our centre are comparable with those found in the literature.Contexte : La chirurgie transanale mini-invasive (TAMIS) s'est imposée comme une technique relativement nouvelle pour le traitement du cancer précoce et des lésions bénignes du rectum. La technique est en voie d'être adoptée à grande échelle, voire de supplanter d'autres techniques comparables, en raison de sa mise en place facile et de sa rentabilité. Nous avons évalué les résultats de la technique TAMIS dans notre centre.Méthodes : Nous avons fait une analyse rétrospective de données recueillies de façon prospective sur 50 patients traités par TAMIS pour cause de cancer T1 ou T2 malin ou bénin et non candidats à la chirurgie radicale, sur une période de 4 ans. Nous avons évalué les résultats, y compris les complications et la récidive sur 30 jours, ainsi que notre capacité d'adopter et d'intégrer cette technique dans notre centre. Résultats :Les 50 chirurgies TAMIS furent une réussite. La taille moyenne de la lésion était de 7 cm à partir de la marge anale, la taille moyenne de la tumeur était de 2,5 cm, la durée moyenne de la chirurgie était de 73 minutes, la durée moyenne d'hospitalisation était de 1,1 jour et le taux de marges négatives était de 84 %. Parmi les principales indications dans notre série...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Transanal minimally invasive surgery for benign large rectal polyps and early malignant rectal cancers: experience and outcomes from the first Canadian centre to adopt the technique

Caycedo‐Marulanda

Jiang

Kohtakangas

2017

CJS

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“…By contrast, the rectal wound was completely sealed in 95% of the patients whose wounds were sutured. Even if the defect was left open, continence was not compromised at one year following the surgery (25). These results suggest that it may be advantageous for the defect to be left open.…”

Section: Discussionmentioning

confidence: 77%

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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“…A bowel preparation is needed but the type can be left up to the surgeon's preference. 53 Some may prefer to have their patients perform a full mechanical bowel preparation, 54,55 but a flexible sigmoidoscopy preparation (dose of oral laxative and 2 enemas) is more than adequate for visualization in most patients. The complication of colonic gas explosion has not been encountered, most likely due to the fact that CO2 is used for insufflation and that the smoke, and therefore methane gas, is vented during the procedure.…”

Section: A Surgical Preparationmentioning

confidence: 99%

Transanal Minimally Invasive Surgery (TAMIS): a clinical spotlight review

2017

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Teresa deBeche-Adams, Imran Hassan, and the SAGES Guidelines Committee PreambleThe following clinical spotlight review regarding Transanal Minimally Invasive Surgery (TAMIS) is intended for physicians who manage and treat rectal pathology. It is meant to critically review this technique and the available evidence supporting its safety and efficacy. Based on the level of evidence, recommendations may or may not be given for its use in clinical practice. DisclaimerGuidelines for clinical practice and spotlight reviews are intended to indicate preferable approaches to medical problems as established by experts in the field. These recommendations will be based on existing data or a consensus of expert opinion when little or no data are available. Spotlight reviews are applicable to all physicians who address the clinical problem(s) without regard to specialty training or interests, and are intended to convey recommendations based on a focused topic; within the defined scope of the review, they indicate the preferable, but not necessarily the only acceptable approaches due to the complexity of the healthcare environment. Guidelines and recommendations are intended to be flexible. Given the wide range of specifics in any healthcare problem, the surgeon must always choose the course best suited to the individual patient and the variables in existence at the moment of decision. Guidelines, spotlight reviews, and recommendations are developed under the auspices of the Society of American Gastrointestinal Endoscopic Surgeons and its various committees, and approved by the Board of Governors. Each clinical spotlight review has been systematically researched, reviewed and revised by the guidelines committee, and, when appropriate, reviewed by an appropriate multidisciplinary team. The recommendations are therefore considered valid at the time of production based on the data available. Literature reviewA systematic literature search was performed using PubMed for Transanal Minimally Invasive Surgery (TAMIS). The literature was reviewed from September 1, 2010 through May 31, 2016. Both the quality of the evidence and the strength of the recommendation for each of the guidelines were assessed according to the GRADE system. This uses a 4-tiered system for denoting the quality of evidence (very low (+), low (+ +), moderate (+ + +), or high (+ + + +)) and a 2-tiered system for strength of recommendation (weak, or strong).

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Transanal minimal invasive surgery for rectal lesions: should the defect be closed?

Abstract: Transanal rectal resection can be safely and efficiently performed by means of a SILS port and standard laparoscopic instruments. The rectal defect may be left open and at 1 year continence is not compromised.

Cited by 94 publications

References 29 publications

Transanal minimally invasive surgery for benign large rectal polyps and early malignant rectal cancers: experience and outcomes from the first Canadian centre to adopt the technique

Transanal minimally invasive surgery for benign large rectal polyps and early malignant rectal cancers: experience and outcomes from the first Canadian centre to adopt the technique

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

Transanal Minimally Invasive Surgery (TAMIS): a clinical spotlight review

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