Transanal endoscopic microsurgery – impact on the practice of a colorectal surgeon in a district general hospital

Abstract

INTRODUCTIONThe objective was to assess the impact on the management of colorectal patients treated in a district general hospital within the first year after the introduction of transanal endoscopic microsurgery (TEM).PATIENTS AND METHODS Data were collected for consecutive unselected patients who underwent TEM. Comparative data were derived from a matched group of patients who underwent anterior resection, peranal procedures (PAR) or transanal resection (TAR) in this unit.RESULTS Twenty-two patients underwent TEM (11 men and 11 women; aged, 29-87 years; median, 75 years). Eighteen patients had a pre-operative diagnosis of benign rectal neoplasms; three were found to have invasive carcinoma, which might have been missed during TAR. Four patients had a pre-operative diagnosis of rectal cancer and TEM provided local tumour control in three cases. The operating time ranged between 20-150 min (mean, 65 min; median, 57 min). Hospital stay ranged between 0-10 days (mean, 3.7 days; median, 3 days), with a total of 97 in-patient days for the entire group of patients. Twenty-four operations were performed (22 TEM and two salvage anterior resections), with an estimated cost of £1544 for consumables used. Alternative treatments in the absence of TEM were considered to involve 10 anterior resections, 5 closures of ileostomy, 30 TAR procedures and one PAR procedure, with an estimated 306 days of in-patient admission, 46 operations and £6245 spent on consumables.CONCLUSIONS Availability of TEM allows more efficient treatment for a significant number of patients with rectal tumours. The cost of the equipment is offset by a significant decrease in the length of in-patient admissions.

Transanal endoscopic microsurgery: indications, results and controversies

“…TEM is usually a quick procedure with an average operating time around 67 min [4,46,47]. The complication rate is approximately 10%, being mainly minor complications include fever, urinary retention, rectal bleeding and pain.…”

“…Compared to rectal resections such as low anterior resection or abdominoperineal resection, TEM has a reduced morbidity and mortality, the hospital length of stay is shorter and the reoperation rate lower [20,47]. Also, TEM is quicker to perform, does not require an abdominal incision, and is associated with less postoperative pain.…”

Transanal endoscopic microsurgery

“…Die TEM ist normalerweise ein kurzer Eingriff mit einer durchschnittlichen Operationsdauer von etwa 67 min [4,46,47]. Die Komplikationsrate liegt bei annähernd 10%, da es sich hauptsächlich um Minor-Komplikationen einschließ-lich Fieber, Harnverhalt, rektaler Blutungen und Schmerzen handelt.…”

“…Im Vergleich zu rektalen Resektionen wie der tiefen anterioren Resektion oder der abdominoperinealen Resektion weist die TEM eine reduzierte Morbidität und Mortalität auf, der Klinikaufenthalt ist kürzer und die Reoperationsrate niedriger [20,47]. Auch lässt sich die TEM schneller durchführen, sie setzt keine abdominelle Inzision voraus, und sie ist mit geringerem postoperativem Schmerz assoziiert.…”

Transanal endoscopic microsurgery (TEM): a minimally invasive procedure for treatment of selected rectal neoplasms

“…Complications TEM is usually a quick procedure with an average operating time around 67 minutes 12,28,34 . Complication rate is approximately around 10%, being fever, urinary retention, rectal bleeding and pain the most common.…”