Glove Port Technique for Transanal Endoscopic Microsurgery

Abstract

Introduction. Despite initial enthusiasm, the use of transanal endoscopic microsurgery (TEM) is still quite limited at present because of the expense of highly specialized equipment and the complexity of the learning curve. Furthermore, some authors report a relevant, although temporary, effect on anorectal function because of the considerable anal dilatation which can even produce a rupture of the internal anal sphincter. The “glove TEM” proposes itself as an alternative to traditional TEM that could settle these problems. Materials and Methods. The technique is accurately described together with the necessary equipment to perform it. Between 2011 and 2012, we operated eight patients with this technique for rectal adenomas or early carcinomas achieving R0 resection in all cases and reporting no early or late complications during the first five months of followup. Discussion. This technique offers multiple advantages compared to the original TEM. (i) It allows the use of all available laparoscopic instruments. (ii) It gives a great manoeuvrability of the instruments in contrast to rigid rectoscope systems. (iii) Given the limited length of the device, it permits to operate on tumors closer to the dentate line. (iv) It is less traumatic to the anal sphincter. It is definitively much cheaper. Conclusions. We believe that this new technique is easy to perform, cost-effective, and less traumatic to the anal sphincter compared to traditional TEM.

Transanal Minimally Invasive Surgery for Rectal Lesions

“…The literature review presented in Table 2 , including 513 patients with benign and malignant rectal tumors, demonstrated a 16.8% postoperative complication rate (range, 0–23%). 4 , 7 – 15 , 17 – 28…”

“…In the present series, the en bloc resection and R0 resection rates were 100% and 96.8%, respectively, and these outcomes are comparable to the literature data for TAMIS technique, describing a 5.6% R1 rate (29/513; Table 2 ). 4 , 7 – 15 , 17 – 28…”

“…However, these data are in contrast to the relatively rapid spread of the use of TAMIS in clinical practice, especially among colorectal surgeons who do not routinely performed TEM. 14 , 15 , 17 Moreover, some authors with experience in TEM surgery have started to publish TAMIS surgery reports with encouraging data on functional results. 18 …”

Transanal endoscopic microsurgery for early rectal cancer: single center experience.

“…Standard TEM equipment was used in our series. However, to overcome high costs, a ‘glove port’ and standard laparoscopic instruments can be utilized [ 10 , 11 ]. When performing TEM, determination of the peritoneal reflection is important to avoid injury to the bowel.…”

An evaluation of trans-anal rectoscopic-assisted minimally invasive surgery (ARAMIS): a new platform for transanal surgery

“…Both are easily positioned transanally and allow insufflation through a separate channel. Other devices have been proposed for TAMIS operation: Triport Access System [7], Single Site Laparoscopic Access System [8], GelPOINT Path Long Channel transanal access platform (Applied Medical, Rancho Santa Margarita, CA) [9], and Glove port [10].…”