title: Harmonic long shears further reduce operation time in transanal endoscopic microsurgery.
abstract: BACKGROUND
  Previous research indicates that application of 5-mm harmonic shears rather than diathermia significantly reduces operation time in transanal endoscopic microsurgery (TEM). Frequently, however, additional instruments were required to complete resection. We investigated whether the new 5-mm harmonic long shears (H-LS) are better equipped for TEM compared with regular harmonic shears (HS).
  
  
  METHODS
  Between 2001 and 2006, 162 tumors (117 adenomas, 42 carcinomas, and 3 other tumors; mean distance 6.6 cm, mean area 40 cm(2)) were excised in 161 patients (82 men, 79 women; mean age 66 years).
  
  
  RESULTS
  Eighty-eight resections were performed with HS and 74 with H-LS. Tumor and patient characteristics were similar except for specimen area. Tumors resected by H-LS were on average smaller than those resected by HS (34.4 versus 44.1 cm(2); Mann-Whitney U-test: p = 0.027). Mean operation time was 48 min and proportional to area in both groups (univariate analysis of variance p < 0.001). Mean operation time was 54 min using HS and 41 min using H-LS (t-test: p < 0.001). After correction for area, operation time for H-LS was reduced by 14% compared with HS (t-test: p < 0.001). H-LS is singly capable of completing resection in 88% compared with 26% for HS (Mann-Whitney U-test: p < 0.001). Mean blood loss was 16 cc for HS and 3 cc for H-LS (p < 0.001). Morbidity (11%) and mortality (0.6%) were not different between the two groups (Fisher's exact test).
  
  
  CONCLUSIONS
  Performing transanal endoscopic microsurgery with 5-mm harmonic long shears reduces operation time compared with regular shears, and completing resection seldom requires other instruments.
authors.affiliation: Department of Surgery, IJsselland Hospital, Prins Constantijnweg 2, Capelle aan den IJssel, 2906 ZC, The Netherlands.
authors.forename: Pleun E A
authors.initials: PE
authors.lastname: Hermsen
authors.forename: Ifesegun D
authors.initials: ID
authors.lastname: Ayodeji
authors.forename: Wim H C
authors.initials: WH
authors.lastname: Hop
authors.forename: Geert W M
authors.initials: GW
authors.lastname: Tetteroo
authors.forename: Eelco J R
authors.initials: EJ
authors.lastname: de Graaf
mesh_terms: D000236:Adenoma / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001003:Anal Canal; D016063:Blood Loss, Surgical; D002277:Carcinoma / Q000601:surgery; D004564:Electrocoagulation; D004867:Equipment Design; D005260:Female; D057086:High-Intensity Focused Ultrasound Ablation / Q000295:instrumentation*; D006801:Humans; D007432:Intraoperative Period; D008297:Male; D008866:Microsurgery / Q000295:instrumentation*; D008875:Middle Aged; D011351:Proctoscopy / Q000379:methods*; D011446:Prospective Studies