LaparoscopyTransanal endoscopic microsurgery for rectal tumors: the St. Mary’s experience
Section snippets
Materials and Methods
Patients undergoing TEMS between 1996 and 2005 at St Mary’s Hospital in London were identified from a prospective colorectal database. During this time period, TEMS was performed in 76 patients with rectal tumors. The mean age of the patients was 66.3 (37 to 91) years. The male-to-female ratio was 48:28.
All patients underwent preoperative endoscopic biopsy and radiologic staging by magnetic resonance imaging and/or endoscopic ultrasound. The preoperative histologic diagnosis was benign adenoma
Results
Mean operating time was 80.6 (38–180) minutes, and the mean hospital stay was 3.2 (1 to 51) days. Mortality among the patients in our study was 0%. Overall morbidity was 18.4% because 14 patients developed minor or major complications (4 patients or 5.2%). Three patients had perioperative complications, ie, perforation of the intraperitoneal rectum, and the defect could not be closed primarily by way of the TEMS rectoscope. Two of these patients were treated by conversion to anterior resection
Comments
TEMS is a minimally invasive sphincter-preserving procedure that currently plays an expanding role in the surgical management of rectal tumors. When colonoscopic polypectomy fails to remove large and sessile adenomas because of technical reasons, surgical options include either local resection or major operations, such as low anterior and abdominoperineal resection [1]. The most important factor in avoiding local recurrence after local excision of a rectal adenoma is the complete removal of the
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Transanal minimally invasive surgery (TAMIS) for local excision of selected rectal neoplasms: Efficacy and outcomes in the first 11 patients
2014, Journal of ColoproctologyCitation Excerpt :Compared to local excision, TEM provides superior quality of resection, decreased local recurrence, and improved survival, particularly among patients with adenomas4 and histologically favorable stage I rectal cancer.3,5 In long-term follow-up, TEM excision of rectal tumors has proven to be safe and effective, with morbidity and mortality similar to that of conventional transanal excision.6,7 However, although TEM has been in use for more than 20 years, it has been slow to become universally adopted by colorectal surgeons, partly due to a long learning curve, but also because of the significant cost of the highly specialized equipment.2–4
Transanal Endoscopic Microsurgery
2012, Shackelford's Surgery of the Alimentary Tract: Volume 1-2, Seventh EditionPolypoid rectal mass in a 21-year-old woman with hematochezia
2011, GastroenterologyTransanal endoscopic microsurgery: A review
2014, Canadian Journal of SurgeryTransanal endoscopic microsurgery of rectal tumor a review
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