Gasless video endoscopic transanal excision of rectal tumors incompletely removed by colonoscopic snare polypectomy.
BACKGROUND
This report describes an experience with gasless video transanal endoscopic microsurgery (VTEM) to excise rectal tumors previously incompletely removed with colonoscopic snare polypectomy.


METHODS
Gasless VTEM involves a modification of transanal endoscopic microsurgery (TEM) that incorporates a standard laparoscopic video camera and requires no CO(2) insufflation system. Nineteen patients who had had a rectal tumor removed incompletely by colonoscopic polypectomy with a diathermy snare were enrolled in this prospective study. The patients included 14 men and 5 women whose median age was 63.5 (range, 49-83) years. The rectal tumors included 4 adenomas, 11 adenocarcinomas (Tis, 7; T1, 4), and 4 carcinoid tumors. The median distance from the tumor margin to the dentate line was 5.8 (range, 2.0-13.0) cm.


RESULTS
All rectal lesions were successfully removed by gasless VTEM. No intraoperative complication occurred. The median operating time and blood loss were 40 (range, 15-145) minutes and 5 (range, 0-100) mL, respectively. The median maximal tumor diameter in 9 patients with residual tumors was 1.3 (range, 0.5-2.5) cm. There was no operative mortality. A postoperative complication (bleeding from a suture wound and transient incontinence) developed in 1 (5.3%) of the 19 patients. The median postoperative hospital stay was 5 (range, 2-10) days. Postoperative histology revealed a residual tumor in 10 (52.9%) of the 19 specimens. Complete excision of all tumors was confirmed histologically. During a median follow-up period of 59.5 (range, 12.3-94.9) months, no tumor recurred.


CONCLUSIONS
Gasless VTEM is useful and minimally invasive for the local removal of rectal tumors incompletely resected by colonoscopic snare polypectomy.
First Department of Surgery, Nagasaki University School of Medicine, Nagasaki, Japan. nakagoe@net.nagaski-u.ac.jp
Tohru
T
Nakagoe
Hiroshi
H
Ishikawa
Terumitsu
T
Sawai
Takashi
T
Tsuji
Shi-Ichi
S
Shibasaki
Kenji
K
Tanaka
Atsushi
A
Nanashima
Hiroyuki
H
Yamaguchi
Toru
T
Yasutake
Hiroyoshi
H
Ayabe
D000230:Adenocarcinoma / Q000601:surgery*; D000236:Adenoma / Q000601:surgery*; D000368:Aged; D000369:Aged, 80 and over; D003113:Colonoscopy; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012004:Rectal Neoplasms / Q000601:surgery*; D012086:Reoperation; D016896:Treatment Outcome; D020535:Video-Assisted Surgery / Q000379:methods*