Transanal Endoscopic Video-Assisted Excision: Application of Single-Port Access

Ragupathi, Madhu; Haas, Eric M.

doi:10.4293/108680810x12924466009005

Cited by 37 publications

(25 citation statements)

References 28 publications

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“…The most critical issue is suturing. Other authors recently reported difficulties in repairing the excision defect so that different methods have been proposed, including use of an endo-GIA stapler [9], intracorporeal suture-tying [11,12], or interrupted sutures with extracorporeal knots that are secured with a knot-pusher [10]. In any case, the maneuver is very challenging and an ideal technique has not been described yet.…”

Section: Discussionmentioning

confidence: 99%

“…as TransAnal Mini-Invasive Surgery (TAMIS) [9,10], Transanal Single-Port Microsurgery (TSPM) [11], Transanal Endoscopic Video-Assisted surgery (TEVA) [12], and SILSTEM [13], has been adopted. In all these procedures, a single-incision laparoscopic surgery port is introduced into the anal canal, followed by transanal excision using standard laparoscopic instruments.…”

mentioning

confidence: 99%

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TransAnal Minimally Invasive Surgery (TAMIS) with SILS™ Port versus Transanal Endoscopic Microsurgery (TEM): a comparative experimental study

Rimonda¹,

Arezzo

Arolfo

et al. 2013

Surg Endosc

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The definitive version is available at: La versione definitiva è disponibile alla URL: http://link.springer.com/article/10.1007%2Fs00464-013-2962 Since clinical application has begun in the absence of any experimental validation, we assessed its feasibility and efficacy ex vivo in a pilot study. Methods In a dedicated trainer box for transanal procedures, 10 surgeons with no experience in transanal surgery were asked to perform a dissection/suture task using both TAMIS and TEM in randomly allocated order. Surgeons were asked to dissect two identically drawn lesions of ~3 cm in larger diameter. Precision of dissection was assessed using a quantitative photographic method, while the time needed for dissection and suturing was considered a measure of quantitative evaluation. Each participant expressed a subjective opinion regarding difficulty with dissection, difficulty with suturing, vision quality, and conflict between instruments on a scale from 1 to 5. ResultsNo difference was observed between the two techniques regarding the accuracy of dissection as the margin was interrupted along 4.1 % of the circumference in the TEM group compared with 2.48 % in the SILS group (P = 0.271). Dissection and suturing were significantly quicker in the TEM group [04:30 vs. 06:35 min (P = 0.049) and 14:34 versus 19:18 min (P = 0.003)]. In three cases in the SILS group, completing the suture was not considered possible, and the procedures were terminated by TEM. Subjective evaluation revealed a better appreciation of TEM in all proposed comparisons: dissection (2.6 vs. 3.5, P = 0.004), suturing difficulty (3.1 vs. 4.6, P < 0.001), quality of vision (2.3 vs. 2.8, P = 0.18), and instrument conflicts (3.1 vs. 4.0, P = 0.054). Conclusions In the ex vivo setting, both techniques were comparable for achieving a good dissection, although TAMIS failed to prove effective in suturing the rectal wall. Moreover, TEM was significantly quicker despite the small groups and was better appreciated by the surgeons.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

TransAnal Minimally Invasive Surgery (TAMIS) with SILS™ Port versus Transanal Endoscopic Microsurgery (TEM): a comparative experimental study

Rimonda¹,

Arezzo

Arolfo

et al. 2013

Surg Endosc

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“…since its initial description, small series and case reports have shown tamis to be a feasible, low-cost alternative to tem. [13][14][15][16][17][18][19][20] Despite its increasing use, the efficacy of local excision using tamis has not yet been proven.…”

mentioning

confidence: 99%

Transanal Minimally Invasive Surgery (TAMIS) for Local Excision of Benign Neoplasms and Early-stage Rectal Cancer

Albert

Atallah

deBeche-Adams

et al. 2013

Diseases of the Colon &Amp; Rectum

236

137

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“…The lithotomy position is suitable for most tumor resections, even in lesions of the anterior rectal wall 1,3,4 . The attachment of an external arm to the surgical table is also not needed.…”

Section: Discussionmentioning

confidence: 99%

“…This technique has proven to be effective and safe in treating early rectal tumors and polyps. When compared with traditional techniques as local excision, TEM has the advantages of better visualization of the rectum, access to higher lesions and better ability to obtain clear margins with the possibility of excision without fragmentation of the surgical specimen [1][2][3][4][5][6][7][8][9][10][11][12][13] . The high cost of the equipment and surgical instruments added to the limited number of indications for its use, consequently, lead to a long learning curve.…”

Section: Introductionmentioning

confidence: 99%

Transanal minimally invasive surgery with single-port (TAMIS) for the management of rectal neoplasms: a pilot study

Filho¹,

Costa²,

Guerra³

2012

J. Coloproctol. (Rio J.)

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Alves Filho EF, Costa PFO, Guerra JC. Transanal minimally invasive surgery with single-port (TAMIS) for the management of rectal neoplasms: a pilot study. J Coloproctol, 2012;32(4): 402-406. ABSTRACT:Transanal endoscopic microsurgery (TEM) has been used since the 1980's for the treatment of selected rectal cancers, with clear benefits regarding morbidity and mortality, and good oncological outcomes when compared to radical surgery and conventional local resections. The high cost of equipment and the need for long learning curve did not allow the spread of the technique. The aim of this study was to describe the technical characteristics and outcomes of 4 patients operated by this technique, 3 with histologically confirmed adenomas and 1 carcinoid rectal tumor, with no recurrence after an average follow-up of 12 months. The use of single port devices for transanal surgery is a safe method with good oncological results and allows a faster learning curve, by the similarity with conventional laparoscopic procedures and the availability of devices commonly used in laparoscopy. Keywords: colorectal surgery; rectal neoplasms; TAMIS; laparoscopy.ReSumo: A microcirurgia endoscópica transanal (TEM) é usada desde a década de 80 para o tratamento de neoplasias retais selecionadas, com claros benefícios relacionados à mortalidade e morbidade, e com bons resultados oncológicos, em comparação à cirurgia radical e a ressecções locais convencionais. O custo alto de equipamento de TEM e a necessidade de uma curva de aprendizagem longa ainda não permitiram a propagação da técnica. O objetivo deste estudo foi descrever a técnica cirúrgica e os desfechos oncológicos em 4 pacientes operados por esta técnica, 3 com diagnóstico final de adenomas e 1 de tumor carcinoide, sem recorrência após seguimento médio de 12 meses. A utilização de dispositivos de portal único para a cirurgia transanal é um método seguro e com bons resultados oncológicos, permitindo uma curva de aprendizado mais rápida pela semelhança com os procedimentos laparoscó-picos convencionais e pela disponibilidade de dispositivos comumente utilizados em laparoscopia.Palavras-chave: cirurgia colorretal; neoplasias retais; TAMIS; laparoscopia.

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Transanal Endoscopic Video-Assisted Excision: Application of Single-Port Access

Abstract: Transanal endoscopic video-assisted excision of benign and malignant rectal lesions with pneumorectal distension appears to optimize the visual field and avert several of the pitfalls commonly associated with transanal endoscopic microsurgery.

Cited by 37 publications

References 28 publications

TransAnal Minimally Invasive Surgery (TAMIS) with SILS™ Port versus Transanal Endoscopic Microsurgery (TEM): a comparative experimental study

TransAnal Minimally Invasive Surgery (TAMIS) with SILS™ Port versus Transanal Endoscopic Microsurgery (TEM): a comparative experimental study

Transanal Minimally Invasive Surgery (TAMIS) for Local Excision of Benign Neoplasms and Early-stage Rectal Cancer

Transanal minimally invasive surgery with single-port (TAMIS) for the management of rectal neoplasms: a pilot study

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