Potential of Endoscopic Microsurgery

Česká verzia

Authors: L. Starý; I. Klementa; P. Zbořil; P. Skalický ; I. Švach; Č. Neoral
Authors place of work: I. chirurgická klinika LF UP a FN Olomouc, přednosta: doc. MUDr. Č. Neoral, CSc.
Published in the journal: Rozhl. Chir., 2010, roč. 89, č. 12, s. 770-773.
Category: Monothematic special - Original

Summary

Aim:
Evaluate our more than seven year experience with transanal endoscopic microsurgical technique (TEM).

Materials and methods:
The authors prospectively evaluated a set of 393 patients who were operated using the TEM method.

Results:
Out of 393 patients, 371 (94%) were indicated for the procedure for rectal tumor; 82 of these tumors were malignant. Nine patients underwent a rectoplasty for rectal stenosis, and in five patients drainage of a perirectal fluid collection was performed. Four patients underwent the surgical procedure for bleeding from the rectal tumor and in four patients an ulcerous lesion was removed from the rectum. Complications in the set of patients with malignant or benign tumors of the rectum occurred in 21 (6%) cases. Ten patients had bleeding, three patients underwent surgical revision for peritonitis with dehiscence of the intraabdominal bowel suture after transmural resection, periproctal abscess occurred in five patients, rectovaginal fistula was observed in three patients. There was no postoperative mortality.

Conclusion:
Transanal endoscopic microsurgery has become a standard therapeutic procedure. In oncosurgery, for early stages of rectal tumors, it is an equivalent alternative to conventional surgery with the advantages of minimal morbidity, mortality, postoperative complications, and sexual and urological dysfunctions. This, however, is only true when indication criteria are strictly adhered to and principles of resection radicality are maintained.

Key words:
transanal endoscopic microsurgery – operating rectoscope – local therapy of rectal tumors

Zdroje

1. Beral, D. L., Monson, J. R. Is local excision of T2/T3 rectal cancers adequate? Recent Results Cancer Res., 2005; 165: 120–135.

2. Dafnis, G., PĆhlman, L., Raab, Y., Gustafsson, U. M., Graf, W. Transanal endoscopic microsurgery: clinical and functional results. Colorectal Dis., 2004 Sep; 6(5): 336–342.

3. Doornebosch, P. G., Tollenaar, R. A., Gosselink, M. P., Stassen, L. P., Dijkhuis, C. M., Schouten, W. R., van de Velde, C. J., de Graaf, E. J. Quality of life after transanal endoscopic microsurgery and total mesorectal excision in early rectal cancer. Colorectal Dis., 2007 Jul; 9(6): 553–558.

4. Gavagan, J. A., Whiteford, M. H., Swanstrom, L. L. Full-thickness intraperitoneal excision by transanal endoscopic microsurgery does not increase short-term complications. Am. J. Surg., 2004 May; 187(5): 630–634.

5. Glancy, D. G., Pullyblank, A. M., Thomas, M. G. The role of colonoscopic endoanal ultrasound scanning (EUS) in selecting patients suitable for resection by transanal endoscopic microsurgery (TEM). Colorectal Dis., 2005 Mar; 7(2): 148–150.

6. Kinoshita, T., Kanehira, E., Omura, K., Tomori, T., Yamada, H. Transanal endoscopic microsurgery in the treatment of rectal carcinoid tumor. Surg. Endosc., 2007 Jun; 21(6): 970–974. Epub 2007 Feb 7.

7. Kulig, J., Richter, P., Gurda-Duda, A., Gach, T., Klek, S. The role and value of endorectal ultrasonography in diagnosing T1 rectal tumors. Ultrasound Med. Biol., 2006 Apr; 32(4): 469–472.

8. Nano, M., Ferronato, M., Solej, M., D‘Amico T1 adenocarcinoma of the rectum: transanal excision or radical surgery? Tumori, 2006 Nov-Dec; 92(6): 469–473.

9. Quinlan, M., Cahill, R., Keane, F., Grainger, R., Butler, M. Transanal endoscopic microsurgical repair of iatrogenic recto-urethral fistula. Surgeon, 2005 Dec; 3(6): 416–417.

10. Vávra, P., Andel, P., Dostalík, J., Gunková, P., Pelikán, A., Gunka, I., Martínek, L., Vávrová, M., Spurný, P., Curík, R., Koliba, P. The first case of management of the rectovaginal fistule using transanal endocsopic microsurgery. Rozhl. Chir., 2006 Feb; 85(2): 82–85.

11. Vysloužil, K. Komplexní léčba nádorů rekta. Grada, 2005: 72–78.