Glove port technique for transanal endoscopic microsurgery.
Introduction. Despite initial enthusiasm, the use of transanal endoscopic microsurgery (TEM) is still quite limited at present because of the expense of highly specialized equipment and the complexity of the learning curve. Furthermore, some authors report a relevant, although temporary, effect on anorectal function because of the considerable anal dilatation which can even produce a rupture of the internal anal sphincter. The "glove TEM" proposes itself as an alternative to traditional TEM that could settle these problems. Materials and Methods. The technique is accurately described together with the necessary equipment to perform it. Between 2011 and 2012, we operated eight patients with this technique for rectal adenomas or early carcinomas achieving R0 resection in all cases and reporting no early or late complications during the first five months of followup. Discussion. This technique offers multiple advantages compared to the original TEM. (i) It allows the use of all available laparoscopic instruments. (ii) It gives a great manoeuvrability of the instruments in contrast to rigid rectoscope systems. (iii) Given the limited length of the device, it permits to operate on tumors closer to the dentate line. (iv) It is less traumatic to the anal sphincter. It is definitively much cheaper. Conclusions. We believe that this new technique is easy to perform, cost-effective, and less traumatic to the anal sphincter compared to traditional TEM.
1st Division of General Surgery, S. Chiara Hospital, Largo Medaglie d'Oro 1, 38100 Trento, Italy.
Carrara
C
Alessandro
Mangiola
M
Daniela
Motter
M
Michele
Tirone
T
Andrea
Ghezzi
G
Gianmarco
Silvestri
S
Massimo
Zappalà
Z
Orazio
Gasperetti
G
Fabio
Tirone
T
Giuseppe