Transanal single-port microsurgery for rectal tumors: minimal invasive surgery under spinal anesthesia

Lee, Taek-Gu; Lee, Sang-Jeon

doi:10.1007/s00464-013-3184-0

Cited by 58 publications

(38 citation statements)

References 33 publications

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“…A case series of 25 patients reported a positive outcome after using spinal anesthesia during TAMIS; the proposed advantage was improved rectal wall relaxation. 15 We did not experience any difficulty with pneumorectum with the patients under general anesthesia, nor did we experience any important postoperative problems. More studies are likely needed to validate any true clinical benefit of spinal anesthesia.…”

Section: Discussionmentioning

confidence: 81%

Transanal minimally invasive surgery for benign large rectal polyps and early malignant rectal cancers: experience and outcomes from the first Canadian centre to adopt the technique

Caycedo‐Marulanda

Jiang

Kohtakangas

2017

CJS

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Background: Transanal minimally invasive surgery (TAMIS) has emerged as a relatively new technique in treating early cancer and benign lesion of the rectum. The technique is likely to be widely adopted, surpassing other comparable techniques owing to its simple setup and costeffectiveness. We assessed the outcomes of TAMIS at our centre. Methods:We retrospectively reviewed prospectively collected data on 50 patients who underwent TAMIS for benign, malignant T1 or T2 cancers that were unfit for radical surgery over a 4-year period. Outcomes, including 30-day complications and recurrence, as well as our ability to implement and integrate this technique at our centre were assessed.Results: All 50 TAMIS procedures were successful. The average lesion was 7 cm from the anal verge, the average tumour size was 2.5 cm, the average duration of surgery was 73 minutes, the average length of stay was 1.1 days, and the margin negativity was 84%. Major indications in our series included 25 lesions that were too large for endoscopic resection, 14 early cancers or high-grade dysplasia, 10 margin checks postpolypectomy, 6 cases of recurrent polyposis, and 4 medically unfit patients. There were no deaths. The rate of short-term complications, including rectal bleeding, reoperation and urinary retention, was 16%. The rate of long-term complications, including anal incontinence and stenosis, was 4%. Benign and malignant recurrence rates were 2% and 6%, respectively. Overall long-term requirement for invasive procedures, low anterior resection or abdominoperineal resection, was 12%. Conclusion:To our knowledge, this is the first Canadian study showing TAMIS to be an efficient and safe procedure for the treatment of well-selected patients with rectal lesions. Outcomes from our centre are comparable with those found in the literature.Contexte : La chirurgie transanale mini-invasive (TAMIS) s'est imposée comme une technique relativement nouvelle pour le traitement du cancer précoce et des lésions bénignes du rectum. La technique est en voie d'être adoptée à grande échelle, voire de supplanter d'autres techniques comparables, en raison de sa mise en place facile et de sa rentabilité. Nous avons évalué les résultats de la technique TAMIS dans notre centre.Méthodes : Nous avons fait une analyse rétrospective de données recueillies de façon prospective sur 50 patients traités par TAMIS pour cause de cancer T1 ou T2 malin ou bénin et non candidats à la chirurgie radicale, sur une période de 4 ans. Nous avons évalué les résultats, y compris les complications et la récidive sur 30 jours, ainsi que notre capacité d'adopter et d'intégrer cette technique dans notre centre. Résultats :Les 50 chirurgies TAMIS furent une réussite. La taille moyenne de la lésion était de 7 cm à partir de la marge anale, la taille moyenne de la tumeur était de 2,5 cm, la durée moyenne de la chirurgie était de 73 minutes, la durée moyenne d'hospitalisation était de 1,1 jour et le taux de marges négatives était de 84 %. Parmi les principales indications dans notre série...

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Section: Discussionmentioning

confidence: 81%

Transanal minimally invasive surgery for benign large rectal polyps and early malignant rectal cancers: experience and outcomes from the first Canadian centre to adopt the technique

Caycedo‐Marulanda

Jiang

Kohtakangas

2017

CJS

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“…[20,21] Data from TAMIS procedures suggest that the risk of anal sphincter injury and dysfunction is relatively low. [22,23] Some of the limitations inherent to single port surgery also apply to TRRP. Reduced maneuverability, loss of instrument triangulation and the need for advance laparoscopic suturing skills during the vesico-urethral anastomosis are some of the technical limitations of this approach.…”

Section: Discussionmentioning

confidence: 99%

The transrectal single port laparoscopic radical prostatectomy in a cadaver model

Akça¹,

Zargar²,

Autorino³

et al. 2015

Turkish Journal of Urology

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Objective: To explore the feasibility of laparoscopic trans-rectal Natural Orifice Transluminal Endoscopic Surgery (NOTES) radical prostatectomy in a cadaveric model and to define anatomical landmarks of this surgical route. Material and methods:After the ethical clearance, the study was conducted in Turkish Council of Forensic Medicine. With the cadaver in an exaggerated lithotomy position, a full thickness incision was made on the anterior wall of the rectum. The anteriorly visible Denonvilliers' fascia was incised sharply, exposing the posterior surface of the prostate. A single-port device (GelPOINT ® Path) was inserted transanally passing the incision on the anterior wall of the rectum, into the bluntly created space between rectum and prostate. Three, 10 mm ports were placed through the GelPOINT ® Path, at 3, 6, and 9 o'clock positions. A 5 mm, 0° degree lens was introduced at 6 o'clock position; followed by laparoscopic scissors and laparoscopic grasper. Prostatic and periprostatic anatomy was defined as encountered during each step of the procedure. Results:Exposure of the posterior surface of the prostate and seminal vesicles was easily achieved. No additional openings of the rectal wall were made. Surgical specimen was extracted keeping its integrity. Conclusion:Transrectal radical prostatectomy is technically feasible in the cadaver model, being facilitated by previous experience with perineal surgery. Anatomical observations during the present experimental study suggest that the transrectal NOTES route provides good exposure of the operative field and easy access to the posterior surface of prostate, Future experimental endeavors should focus on reproducibility of this approach and feasibility of lymph node dissection using trans-rectal route.

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“…61 Lee et al 62 studied the outcomes in patients undergoing TAMIS under spinal anesthesia and found no abnormalities on endoanal ultrasound 3 months after surgery. 62 The platform used in TAMIS is softer than the rigid platforms, with a smaller diameter therefore is thought to lead to less sphincter injury. 62 …”

Section: Outcomes Functionalmentioning

confidence: 99%

“…62 The platform used in TAMIS is softer than the rigid platforms, with a smaller diameter therefore is thought to lead to less sphincter injury. 62 …”

Section: Outcomes Functionalmentioning

confidence: 99%

Transanal endoscopic surgery: patient selection and perspectives

Petrucci

Sands

2016

OAS

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Abstract:Transanal endoscopic surgery is a 30-year innovation, which has allowed surgeons to treat patients with benign and early malignant rectal tumors using a minimally invasive approach. Its use in colorectal surgery continues to expand and be of interest for surgeons practicing in the minimally invasive surgical era. This review provides an overview of transanal endoscopic surgery, focusing on its different platforms, learning curve, and specific indications for benign and malignant diseases of the rectum. It reviews patient selection, with a focus on patient-and tumor-specific characteristics involved in the selection process, preparation for surgery, complications, and outcomes. Lastly, it reviews novel uses for transanal endoscopic surgery and future prospects.

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Transanal single-port microsurgery for rectal tumors: minimal invasive surgery under spinal anesthesia

Cited by 58 publications

References 33 publications

Transanal minimally invasive surgery for benign large rectal polyps and early malignant rectal cancers: experience and outcomes from the first Canadian centre to adopt the technique

Transanal minimally invasive surgery for benign large rectal polyps and early malignant rectal cancers: experience and outcomes from the first Canadian centre to adopt the technique

The transrectal single port laparoscopic radical prostatectomy in a cadaver model

Transanal endoscopic surgery: patient selection and perspectives

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