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

Walensi, Mikolaj ; Käser, Samuel ; Theodorou, Panagiotis ; Bassotti, Gabrio ; Cathomas, Gieri ; Maurer, Christoph

In: World Journal of Surgery, 2014, vol. 38, no. 2, p. 505-511

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    Titel
    • Transanal Endoscopic Microsurgery (TEM) Facilitated by Video-Assistance and Anal Insertion of a Single-Incision Laparoscopic Surgery (SILS®)-Port: Preliminary Experience
    Autor
    • Walensi, Mikolaj. Department of Surgery, Hospital of Liestal, Affiliated with the University of Basel, Rheinstrasse 26, 4410, Liestal, Switzerland
    • Käser, Samuel. Department of Surgery, Hospital of Liestal, Affiliated with the University of Basel, Rheinstrasse 26, 4410, Liestal, Switzerland
    • Theodorou, Panagiotis. Department of Surgery, Hospital of Liestal, Affiliated with the University of Basel, Rheinstrasse 26, 4410, Liestal, Switzerland
    • Bassotti, Gabrio. Gastroenterology and Hepatology Section, Department of Clinical and Experimental Medicine, University of Perugia, Perugia, Italy
    • Cathomas, Gieri. Cantonal Institute of Pathology, Hospital of Baselland, Liestal, Switzerland
    • Maurer, Christoph. Department of Surgery, Hospital of Liestal, Affiliated with the University of Basel, Rheinstrasse 26, 4410, Liestal, Switzerland
    Dokumententyp
    • Postprint
    Sprache
    • Englisch
    Veröffentlicht in
    • World Journal of Surgery, 2014, vol. 38, no. 2, p. 505-511. Springer US; http://www.springer-ny.com
    Andere elektronische Ausgabe
    Klassifikation
    • Gesundheit
    OAI-PMH-ID
    • oai:doc.rero.ch:325652
    Summary
    Objective: Transanal endoscopic microsurgery (TEM) is an established method for the resection of benign and early malignant rectal lesions. Very recently, TEM via an anally inserted single incision laparoscopic surgery (SILS®)-port has been proposed to overcome remaining obstacles of the classical TEM equipment. Methods: Nine patients with a total of 12 benign or early stage malignant rectal polyps were operated using the SILS®-port for TEM. Patients' and polyps' characteristics, perioperative and postoperative complications, as well as operating and hospitalization time were recorded. Results: All 12 polyps (ten low-grade adenoma, one high-grade adenoma, one pT2 carcinoma [preoperatively staged as T1]) were resected. Local full-thickness bowel wall resection was performed for three lesions and submucosal resection for nine lesions. Median operating time was 64 (range 30-180)min. No conversion to laparoscopic or open techniques was necessary. The median maximum diameter of the specimen was 25 (range 3-60)mm, fragmentation of polyps was avoidable in 11 of 12 (92%) lesions, and resection margins were histologically clear in 11 of 12 (92%) polyps. Only one patient, in whom three lesions were resected, experienced a complication as postoperative hemorrhage. No mortality occurred. Median hospitalization time was four (range 1-14) days. Conclusions: SILS®-TEM is a feasible and safe method, providing numerous advantages in application, handling, and economy compared with the classical TEM technique. SILS®-TEM might become a promising alternative to classical TEM. Randomized, controlled trials comparing safety and efficacy of both instrumental settings will be needed in the future.