Local excision by transanal endoscopic surgery

Abstract

Transanal endoscopic surgery (TES) consists of a series of anorectal surgical procedures using different devices that are introduced into the anal canal. TES has been developed significantly since it was first used in the 1980s. The key point for the success of these techniques is how accurately patients are selected. The main indication was the resection of endoscopically unresectable adenomas. In recent years, these techniques have become more widespread which has allowed them to be applied in conservative rectal procedures for both benign diseases and selected cases of rectal cancer. For more advanced rectal cancers it should be considered palliative or, in some controlled trials, experimental. The role of newer endoscopic techniques available has not yet been defined. TES may allow for new strategies in the treatment of rectal pathology, like transanal natural orifice transluminal endoscopic surgery or total mesorectal excision.

Robotic transanal microsurgery for high early rectal neoplasia (T0-T1, N0 lesions), case series of 10 patients

“…However, due to the infancy of TAMIS, the literature on complication rates specific for robotic TAMIS is still very limited. Multiple studies have demonstrated that increased distance from the anal verge, anterior, and lateral rectal wall locations are associated with an increased risk for peritoneal violation during TEM and TaTME . In these retrospective reviews, peritoneal violation was not associated with increased risk for short‐term or long‐term complications, or increased rate of local recurrence .…”

Transanal endoscopic surgery: patient selection and perspectives

“…This less-expensive alternative allows surgeons to use standard laparoscopic instruments, including a 5 mm 30° laparoscope and overall laparoscopy setup, making this platform more affordable, and may be more attractive for surgeons with prior laparoscopic experience. 8 As with the TEM platform, the beveled rectoscope is 4 cm in diameter, but this option comes in three different sizes: 7.5, 15, and 20 cm. Instruments ranging from 3 to 14 mm can be inserted into the channels of the rectoscope, including staplers and ultrasonic devices.…”

“…9 TEO differs from TEM in that it is not equipped with binocular vision or a dedicated suction insufflation device. 8 …”

“…Another device approved by the Food and Drug Administration is the GelPOINT Path Transanal Access Platform (Applied Medical, Rancho Santa Margarita, CA, USA), specifically designed for TAMIS procedures. 8 At the time of introduction of TAMIS, it was found to be a feasible, less expensive alternative to TEM with short operating times and no morbidity or mortality at short-term follow-up. 10 Different ports for TAMIS have been developed throughout the years, with port lengths (referring to the actual working port length, not accounting for the external part of the device) ranging from 37 to 44 mm and port diameters between 35 and 40 mm, depending on the brand.…”

“…In addition, MRI is helpful for higher rectal lesions. 8 Although these imaging modalities are acceptable, a greater trend is growing toward using MRI, since it is more widely available than ERUS; the latter is also operator-dependent and may not be available in all centers.…”