Combining ultrasonic dissection and the Storz operation rectoscope.
BACKGROUND
Transanal endoscopic microsurgery (TEM) allows a precise, full-thickness resection of rectal tumors anywhere within the rectum. Unfortunately, the standard TEM technique needs complex and rather expensive equipment, demands high skill, and is attended by bleeding and oozing that may be challenging. A modified TEM procedure combining the new Storz operation rectoscope and ultrasonic dissection has been developed to overcome the limitations of the original technique.


METHODS
The Storz operation rectoscope features a 5-mm telescope combined with a single-monitor display. Standard laparoscopic instruments and the LCSC5 Ultracision Maniple are used for dissection and coagulation. Full-thickness resection is performed most often. Closure of the defect is accomplished by interrupted 3-0 polydoxanone sutures secured by extracorporeal slipknots.


RESULTS
Altogether, 18 TEMs have been performed according to the modified technique: 9 for malignant and 9 for benign lesions. The median operating time was 92.5 min for resection of malignant lesions and 40 min for resection of benign lesions. Two postoperative complications occurred: a bleeding and a partial dehiscence. The median follow-up periods were 35 months for malignant disease and 19.5 months for benign disease. No recurrence was observed.


CONCLUSIONS
For tumors located up to 15 cm from the anal verge, TEM with the Storz rectoscope and ultrasonic dissection is indicated. Despite the complication described, coagulation is optimal and ultrasonic scissors allow working in a fairly bloodless field. The overall costs of the equipment are significantly lower.
Department of Surgery, Ospedale S. Giovanni, Via Amba Aradam 8, 00184 Rome, Italy. marcomlirici@tiscalinet.it
M M
MM
Lirici
M
M
Di Paola
C
C
Ponzano
C G S
CG
Hüscher
D000230:Adenocarcinoma / Q000601:surgery; D000236:Adenoma / Q000601:surgery; D018253:Adenoma, Villous / Q000601:surgery; D002278:Carcinoma in Situ / Q000601:surgery; D000075202:Contraindications; D003362:Cost-Benefit Analysis; D004867:Equipment Design; D006488:Hemostasis, Surgical / Q000295:instrumentation / Q000379:methods; D006801:Humans; D042282:Microdissection / Q000295:instrumentation / Q000379:methods; D008866:Microsurgery / Q000191:economics / Q000295:instrumentation / Q000379:methods*; D020700:Proctoscopes / Q000191:economics; D011351:Proctoscopy / Q000191:economics / Q000379:methods*; D012004:Rectal Neoplasms / Q000601:surgery*; D013536:Suture Techniques; D018084:Ultrasonography, Interventional / Q000191:economics / Q000295:instrumentation*