title: Video-assisted gasless transanal endoscopic microsurgery: a review of 217 cases of rectal tumors over the past 10 years.
abstract: BACKGROUND
  Transanal endoscopic microsurgery (TEM) has been suggested as a minimally invasive procedure of low morbidity for rectal tumor excision. However, the complicated setup of TEM instruments and the expensive cost are disadvantages to wider acceptance. The aims of this study are to introduce a new modality of modified video-assisted gasless TEM (V-TEM) using a video system and no CO(2) insufflation of the rectum, and discuss our experience during past 10 years.
  
  
  METHODS
  217 patients, with a mean follow-up of 61 months, underwent V-TEM for adenoma (n = 102), Tis (n = 83), T1 (n = 28) and T2 (n = 4) rectal tumors, located 3-20 cm from the dentate line.
  
  
  RESULTS
  The mean size of the tumor was 39 mm, and the mean duration of the operation was 63 min including setup time, and the mean duration of hospital stay was 5.8 days. Seven (3.2%) patients underwent conversion to radical surgery owing to T1 with massive invasion or T2 tumors histopathologically. Two (0.9%) patients had recurrent disease which was managed by repeat V-TEM. The postoperative course in all patients was free from any significant complications. Transient fecal soiling was present in 12 (5.5%) patients. The cost of V-TEM was decreased compared to that of conventional TEM (USD 40000).
  
  
  CONCLUSIONS
  V-TEM was a cheap, safe, simple and minimally invasive procedure for benign and early cancer in the proximal rectum.
authors.affiliation: Department of Surgery, Kurume University School of Medicine, Kurume, Japan. yaraki@med.kurume-u.ac.jp
authors.forename: Y
authors.initials: Y
authors.lastname: Araki
authors.forename: H
authors.initials: H
authors.lastname: Isomoto
authors.forename: K
authors.initials: K
authors.lastname: Shirouzu
mesh_terms: D000236:Adenoma / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016099:Endoscopy, Gastrointestinal / Q000191:economics / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008866:Microsurgery / Q000379:methods; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D012004:Rectal Neoplasms / Q000191:economics / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome; D020535:Video-Assisted Surgery