title: Harmonic scalpel in transanal microsurgery.
abstract: OBJECTIVE
  Retrospective clinical study of patients with rectal tumors treated by transanal endoscopic microsurgery (TEM) using Ultracision.
  
  
  METHODS
  From 1997-2006 54 patients were treated by excision of the rectal tumors situated in the middle and distal portion, using the harmonic scalpel. We treated 25 male (range 40-76 years) and 29 female (range 46-80 years) patients. Tumors were benign or well or moderately differentiated carcinomas in stage T1N0M0 or T2N0M0. Excision was done by Ultracision (UltraCision, Ethicon Endo-Surgery) to all patients. Preoperative examinations were: colonoscopy, biopsy, tumor markers, CT, transanal ultrasound, pelvic NMR, gynecological exam in females. The tumors were excised by harmonic scalpel after submucosal infiltration of adrenalin (1: 200 000) and 2% lidocaine.
  
  
  RESULTS
  There was no morbidity or mortality in this group of patients. Histopathology was: Adenoma tubovillosum in alteratio maligna 20, adenocarcinoma (T1N0M0) 6, (T2N0M0) 8, adenocarcinoma with lymphatic vessels and perineural spaces invasion 1, adenoma villosum 12 and adenoma tubulare 7. After surgical treatment 8 patients underwent adjuvant radiotherapy. There was no local recurrence during this period.
  
  
  CONCLUSIONS
  TEM is a method of choice in the treatment of rectal benign tumors and malignant tumors in stage T1N0M0, grade 1 and 2. Harmonic scalpel provides a safer, easier, and more precise surgical section through clean, bloodless and better visualized operative field.
authors.affiliation: Department of Surgery, University Hospital Split, Split, Croatia. ndruzija@kbsplit.hr
authors.forename: Nikica
authors.initials: N
authors.lastname: Druzijanić
authors.forename: Zdravko
authors.initials: Z
authors.lastname: Perko
authors.forename: Damir
authors.initials: D
authors.lastname: Kraljević
authors.forename: Josko
authors.initials: J
authors.lastname: Juricić
authors.forename: Marina Maras
authors.initials: MM
authors.lastname: Simunić
authors.forename: Kanito
authors.initials: K
authors.lastname: Bilan
authors.forename: Dragan
authors.initials: D
authors.lastname: Krnić
authors.forename: Zenon
authors.initials: Z
authors.lastname: Pogorelić
authors.forename: Snjezana
authors.initials: S
authors.lastname: Tomić
authors.forename: Darko
authors.initials: D
authors.lastname: Srsen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D013505:Digestive System Surgical Procedures / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008866:Microsurgery / Q000379:methods*; D008875:Middle Aged; D012004:Rectal Neoplasms / Q000601:surgery*; D012189:Retrospective Studies; D014463:Ultrasonography