title: Technique and results of transanal endoscopic microsurgery in early rectal cancer.
abstract: The anatomy of the pelvis makes it difficult to perform local excisions in the rectum when the tumor is some distance from the anal verge. We have, therefore, developed a new minimally invasive technique for tumor resection. A rectoscope with a 40-mm diameter permits tumor resection under stereoscopic control in the gas-dilated rectal cavity. Excisions in full-thickness technique up to segmental resections with end-to-end anastomosis can be performed. In selected cases, local excision of a small rectal cancer can be regarded as appropriate treatment. However, most local resections of carcinomas are performed when removal of an adenoma is planned, and the postoperative histology shows a carcinoma. Since 1983, we have operated on 326 patients, 274 who have been enrolled in a prospective clinical trial. Definitive histologic examination proved that 74 of these tumors were carcinomas. The rate of severe complications in patients with carcinomas was 9%, and the mortality rate was 0%. The advantages of this new technique are: The stereoscopic magnified view in the gas-dilated rectum allows precise surgery in an operative field that is otherwise difficult to reach. During the postoperative period, minimal discomfort and pain result in a short hospitalization.
authors.affiliation: Department of General Surgery, University of Tübingen, Germany.
authors.forename: G
authors.initials: G
authors.lastname: Buess
authors.forename: B
authors.initials: B
authors.lastname: Mentges
authors.forename: K
authors.initials: K
authors.lastname: Manncke
authors.forename: M
authors.initials: M
authors.lastname: Starlinger
authors.forename: H D
authors.initials: HD
authors.lastname: Becker
mesh_terms: D000236:Adenoma / Q000453:epidemiology / Q000601:surgery*; D002277:Carcinoma / Q000453:epidemiology / Q000601:surgery*; D020776:Endoscopes, Gastrointestinal; D005069:Evaluation Studies as Topic; D006801:Humans; D008866:Microsurgery / Q000379:methods*; D011446:Prospective Studies; D012004:Rectal Neoplasms / Q000453:epidemiology / Q000601:surgery*; D012007:Rectum / Q000601:surgery*