Ultracision Harmonic Scalpel and multifunctional tem400 instrument complement in transanal endoscopic microsurgery: a prospective study.
BACKGROUND
For transanal endoscopic microsurgery, the ultracision Harmonic Scalpel (UC) and the multifunctional TEM400 instrument (T400) seem advantageous. This study investigated their clinical use.


METHODS
Prospective analysis of tumor, patient, and operation characteristics was performed for 196 tumor resections per instrument intended for application.


RESULTS
The T400 instrument was applied in 162 operations, and the UC in 34 operations. Tumor and patient characteristics were similar except for tumor area (respectively, 7.5 and 17 cm(2); p = 0.003). Operative time was proportionate to the tumor area (p < 0.001) and inversely proportionate to its distance from the dentate line to the lower margin of the tumor of the UC (p = 0.002). Application reduced operative time by 26% (p = 0.02, corrected for area). Whereas, T400 was always singly sufficient for excision, the UC required T400 application in 50% of operations, especially for larger tumors (p = 0.026), with the result that more rectal wall circumference was captured (p = 0.043). Both groups had similar safety parameters.


CONCLUSIONS
The UC substantially reduced operative time compared with the T400, but frequently required the T400 for procedure completion. The T400 is always singly sufficient.
Ayodeji
I D
ID
Department of Surgery, Erasmus Medical Center, Dr. Molewaterplein 40, Rotterdam, 3015, GD, The Netherlands.
Hop
W C J
WC
Tetteroo
G W M
GW
Bonjer
H J
HJ
de Graaf
E J R
EJ
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001003:Anal Canal; D020776:Endoscopes, Gastrointestinal; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D004867:Equipment Design; D005260:Female; D006801:Humans; D008297:Male; D008866:Microsurgery / Q000295:instrumentation* / Q000379:methods*; D008875:Middle Aged; D011446:Prospective Studies; D012004:Rectal Neoplasms / Q000601:surgery*