Transanal excision of rectal villous adenomas by laparoscopic methods

The Ferguson Operating Anoscope as a Minimally Invasive Option for the Treatment of Rectal Tumors

Transanal excision of rectal tumors may be performed using the Ferguson Operating Anoscope (FOA). This retrospective case series evaluates the effectiveness of FOA for the excision of selected benign and malignant rectal tumors. The office records of 97 patients with rectal tumors who underwent FOA transanal excision by a single surgeon from 1999 through 2009 were reviewed. In the 97 patients evaluated, 99 FOA transanal excisions were performed for 39 adenocarcinomas, 55 benign tumors, and five carcinoid tumors. The tumors were 0.5 to 13.5 cm in diameter and located an average of 6.9 cm (range, 1 to 15 cm) from the anal verge. Ninety-one per cent of cases were performed as an outpatient. Postoperative complications occurred in 14 per cent with transient effects on continence in 2 per cent and a mean blood loss of 66 mL. The recurrence rate for favorable T1 rectal cancers was 4.3 per cent and for adenomas was 5.9 per cent. In early follow up of adenomas and favorable T1 carcinomas, FOA transanal excision has similar application, morbidity, and recurrence rates as reported for transanal endoscopic microsurgery for rectal tumors within 15 cm from the anal verge. FOA may be considered a useful option for the minimally invasive treatment of rectal tumors.