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Kim MJ, Lee TG. Transanal minimally invasive surgery using laparoscopic instruments of the rectum: A review. World J Gastrointest Surg 2021; 13:1149-1165. [PMID: 34754384 PMCID: PMC8554714 DOI: 10.4240/wjgs.v13.i10.1149] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 07/18/2021] [Accepted: 09/16/2021] [Indexed: 02/06/2023] Open
Abstract
Transanal minimally invasive surgery (TAMIS) was first described in 2010 as an alternative to transanal endoscopic microsurgery (TEM). The TAMIS technique can be access to the proximal and mid-rectum for resection of benign and early-stage malignant rectal lesions and also used for noncurative intent surgery of more advanced lesions in patients who are not candidates for radical surgery. TAMIS has a shorter learning curve, reduced device setup time, flexibility in instrument use, and versatility in application than TEM. Also, TAMIS shows similar results in a view of the operation time, conversion rate, reoperation rate, and complication to TEM. For these reasons, TAMIS is an easily accessible, technically feasible, and cost-effective alternative to TEM. Overall, TAMIS has enabled the performance of high-quality local excision of rectal lesions by many colorectal surgeons. As TAMIS becomes more broadly utilized such as pelvic abscess drainage, rectal stenosis, and treatment of anastomotic dehiscence, the acquisition of appropriate training must be ensured, and the continued assessment and assurance of outcome must be maintained.
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Affiliation(s)
- Myung Jo Kim
- Department of Surgery, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju 28644, South Korea
| | - Taek-Gu Lee
- Department of Surgery, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju 28644, South Korea
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Leão P, Santos C, Goulart A, Caetano AC, Sousa M, Hogemann G, Parvaiz A, Figueiredo N. TaTME: analysis of the evacuatory outcomes and EUS anal sphincter. MINIM INVASIV THER 2019; 28:332-337. [PMID: 30888248 DOI: 10.1080/13645706.2019.1567555] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Introduction: Some patients undergoing transanal total mesorectal excision (TaTME) may experience post-surgical complications, such as impaired bowel function and urogenital and sexual dysfunction. The present work aims to evaluate the one-year impact of TaTME surgery on bowel function, quality of life, and outcomes.Material and methods: Twenty patients undergoing TaTME with cancer in the mid and lower rectum were assessed prospectively by endoscopic transanal ultrasound (EUS) and three physiological function degrees, along with different clinical outcome questionnaires.Results: EUS sphincter evaluation revealed no structural impact in follow-up. For evacuatory evaluation, differences in the scores of the first postoperative month of Wexner questionnaires were shown when compared to a 12-month period. At least 10% of patients remain with major low anterior resection syndrome (LARS) after one year. The (Fecal incontinence Quality of Life) FiQoL questionnaire revealed that the cases in which values were worse in the first month posteriorly recovered to baseline preoperative values.Conclusions: TaTME does not seem to impact sphincter structure and evacuatory function, with a good recovery rate one year post-surgery, but does not seem to interfere with patients' evacuatory function quality of life.
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Affiliation(s)
- Pedro Leão
- General Surgery, Hospital de Braga, Braga, Portugal.,Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal.,ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | | | - André Goulart
- General Surgery, Hospital de Braga, Braga, Portugal.,Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal.,ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | | | - Maria Sousa
- General Surgery, Hospital de Braga, Braga, Portugal
| | - Gerrit Hogemann
- Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal.,ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Amjad Parvaiz
- Colorectal Surgery, Champalimaud Foundation, Lisboa, Portugal
| | - Nuno Figueiredo
- Colorectal Surgery, Champalimaud Foundation, Lisboa, Portugal
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Chen N, Peng YF, Yao YF, Gu J. Trans-anal minimally invasive surgery for rectal neoplasia: Experience from single tertiary institution in China. World J Gastrointest Oncol 2018; 10:137-144. [PMID: 29988893 PMCID: PMC6033710 DOI: 10.4251/wjgo.v10.i6.137] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 04/26/2018] [Accepted: 05/30/2018] [Indexed: 02/05/2023] Open
Abstract
AIM To evaluate the feasibility and safety of trans-anal minimally invasive surgery (TAMIS) from single institute in China.
METHODS A retrospective review was conducted for patients with rectal neoplasia, who underwent TAMIS using single incision laparoscopic surgery-Port from January 2013 till January 2016 by a group of colorectal surgeons from Gastrointestinal Center Unit III, Peking University Cancer Hospital. Patients’ demographic data, surgical related information, post-operational pathology, as well as peri-operative follow-up were all collected.
RESULTS Twenty-five patients with rectal neoplasia were identified consequently. Complete full-thickness excision was achieved in all cases without conversion. 22 (88%) cases had rectal malignancies [6 were adenocarcinomas and 16 were neuroendocrine tumors (NET)], while 3 patients had adenomas. Mean surgical duration was 61.3 min, and mean post-operative stay were 2.7 d. Post-operational examination demonstrated 5 cases had positive resection margin: 2 adenocarcinoma cases and 1 NET case with positive lateral margin, and the other 2 NET cases with positive basal margin. The curve of operation time for TAMIS cases suggested a minimum of 10 cases for a laparoscopic surgeon proficient with this technique.
CONCLUSION TAMIS was demonstrated to be reproducible and safe, with a relatively short learning process for laparoscopic surgeons in selected cases for rectal neoplasia. Long-term oncological outcome needs to be determined by further investigation.
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Affiliation(s)
- Nan Chen
- Department of Gastrointestinal Center Unit III, Peking University Hospital and Institute, Beijing 100142, China
| | - Yi-Fan Peng
- Department of Gastrointestinal Center Unit III, Peking University Hospital and Institute, Beijing 100142, China
| | - Yun-Feng Yao
- Department of Gastrointestinal Center Unit III, Peking University Hospital and Institute, Beijing 100142, China
| | - Jin Gu
- Department of Gastrointestinal Center Unit III, Peking University Hospital and Institute, Beijing 100142, China
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Ho YM, Mishra A, Ward N. Endoscopic submucosal injection: a novel technique facilitating dissection in transanal minimally invasive surgery (TAMIS). Tech Coloproctol 2018; 22:385-387. [DOI: 10.1007/s10151-018-1795-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 05/05/2018] [Indexed: 01/31/2023]
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Eid Y, Alves A, Lubrano J, Menahem B. Does previous transanal excision for early rectal cancer impair surgical outcomes and pathologic findings of completion total mesorectal excision? Results of a systematic review of the literature. J Visc Surg 2018; 155:445-452. [PMID: 29657063 DOI: 10.1016/j.jviscsurg.2018.03.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Transanal excision (TAE) is increasingly used in the treatment of early rectal cancer because of lower rate of both postoperative complications and postsurgical functional disorders as compared with total mesorectal excision (TME) OBJECTIVE: To compare in a meta-analysis surgical outcomes and pathologic findings between patients who underwent TAE followed by completion proctectomy with TME (TAE group) for early rectal cancer with unfavorable histology or incomplete resection, and those who underwent primary TME (TME group). METHODS The Medline and Cochrane Trials Register databases were searched for studies comparing short-term outcomes between patients who underwent TAE followed by completion TME versus primary TME. Studies published until December 2016 were included. The meta-analysis was performed using Review Manager 5.0 (Cochrane Collaboration, Oxford, UK). RESULTS Meta-analysis showed that completion TME after TAE was significantly associated with increased reintervention rate (OR=4.28; 95% CI, 1.10-16.76; P≤0.04) and incomplete mesorectal excision rate (OR=5.74; 95% CI, 2.24-14.75; P≤0.0003), as compared with primary TME. However there both abdominoperineal amputation and circumferential margin invasion rates were comparable between TAE and TME groups. CONCLUSIONS This meta-analysis suggests that previous TAE impaired significantly surgical outcomes and pathologic findings of completion TME as compared with primary TME. First transanal approach during completion TME might be evaluated in order to decrease technical difficulties.
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Affiliation(s)
- Y Eid
- Department of digestive surgery, university hospital of Caen, avenue de la Côte-de-Nacre, 14033 Caen cedex, France
| | - A Alves
- Department of digestive surgery, university hospital of Caen, avenue de la Côte-de-Nacre, 14033 Caen cedex, France; Centre François-Baclesse, Normandie université, UNICAEN, CHU de Caen, Inserm UMR1086, 3, avenue du Général-Harris, 14045 Caen cedex, France
| | - J Lubrano
- Department of digestive surgery, university hospital of Caen, avenue de la Côte-de-Nacre, 14033 Caen cedex, France; Centre François-Baclesse, Normandie université, UNICAEN, CHU de Caen, Inserm UMR1086, 3, avenue du Général-Harris, 14045 Caen cedex, France
| | - B Menahem
- Department of digestive surgery, university hospital of Caen, avenue de la Côte-de-Nacre, 14033 Caen cedex, France; Centre François-Baclesse, Normandie université, UNICAEN, CHU de Caen, Inserm UMR1086, 3, avenue du Général-Harris, 14045 Caen cedex, France.
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Dapri G. Transanal TME - really needed? Innov Surg Sci 2017; 3:31-38. [PMID: 31579763 PMCID: PMC6754050 DOI: 10.1515/iss-2017-0044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2017] [Accepted: 12/12/2017] [Indexed: 11/15/2022] Open
Abstract
In the last decade, thanks to natural orifice translumenal endoscopic surgery, the application of laparoscopy through the anus has gained interest from both research and clinical point of views. Therefore, an increased number of transanal procedures have been reported, from the resection of a large rectal polyp to total mesorectal excision, and for controlling perioperative complications like leak, bleeding, and stenosis. Currently, the most popular surgical trend remains transanal total mesorectal excision. In this article, the technique, advantages, and disadvantages are discussed.
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Affiliation(s)
- Giovanni Dapri
- Department of Gastrointestinal Surgery, European School of Laparoscopic Surgery, Saint-Pierre University Hospital, Université Libre de Bruxelles, Brussels, Belgium
- Laboratory of Anatomy, Faculty of Medicine and Pharmacy, University of Mons, Mons, Belgium
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Mao W, Liao X, Shao S, Wu W, Yu Y, Yang G. Comparative evaluation of colonoscopy-assisted transanal minimally invasive surgery via glove port and endoscopic submucosal dissection for early rectal tumor. Int J Surg 2017; 42:197-202. [PMID: 28502883 DOI: 10.1016/j.ijsu.2017.05.029] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2017] [Revised: 05/05/2017] [Accepted: 05/07/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND Early rectal tumor is usually managed by local excision. A novel method-colonoscopy-assisted transanal minimally invasive surgery via glove port (CA-TAMIS-GP)-for resecting early rectal tumor was developed and compared with endoscopic submucosal dissection (ESD). MATERIALS AND METHODS We performed CA-TAMIS-GP surgery on 26 patients from January 2014 to February 2016. For better analysis, we retrospectively collected data from 31 patients who underwent ESD between October 2012 and December 2013; overall, 57 patients diagnosed with early rectal tumor were included in this study. Perioperative conditions and long-term outcomes of both groups were compared. RESULTS All lesions were dissected completely and successfully without conversion to open surgery or major complications. On histopathologic examination, all specimens in this study had negative margins. All patients had uneventful postoperative recoveries, except 3 patients of CA-TAMIS-GP with minor hematochezia, which resolved spontaneously; 7 ESD patients had late-onset bleeding and 3 needed colonoscopic hemostasis; 2 patients in each group had mild fever. The CA-TAMIS-GP group had a shorter operation time, less hemorrhage, and a lower average consumable cost than the ESD group (P < 0.05); moreover, the CA-TAMIS-GP group had no recurrence or long-term complications during a follow-up of 10-32 months, whereas3 patients in the ESD group developed local recurrence during a follow-up of 24-36 months. CONCLUSIONS The CA-TAMIS-GP is a new method that is safe and effective in patients with early rectal tumor and appears to have a shorter operation time and less blood loss as compared with ESD.
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Affiliation(s)
- Weiming Mao
- Department of Colorectal Surgery, Hangzhou Number Three People's Hospital, Hangzhou, Zhejiang, 310000, China
| | - Xiujun Liao
- Department of Colorectal Surgery, Hangzhou Number Three People's Hospital, Hangzhou, Zhejiang, 310000, China.
| | - Shuxian Shao
- Department of Colorectal Surgery, Hangzhou Number Three People's Hospital, Hangzhou, Zhejiang, 310000, China
| | - Wenjing Wu
- Department of Colorectal Surgery, Hangzhou Number Three People's Hospital, Hangzhou, Zhejiang, 310000, China
| | - Yanyan Yu
- Department of Colorectal Surgery, Hangzhou Number Three People's Hospital, Hangzhou, Zhejiang, 310000, China
| | - Guangen Yang
- Department of Colorectal Surgery, Hangzhou Number Three People's Hospital, Hangzhou, Zhejiang, 310000, China
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