title: Transanal minimally invasive surgery: initial experience and short-term functional results.
abstract: BACKGROUND
  Currently, the preferred method for local excision of rectal polyps is transanal endoscopic microsurgery, avoiding rectal resection. Transanal minimally invasive surgery is a relatively new technique using a disposable port in combination with conventional laparoscopic instruments. This method is less expensive as compared with transanal endoscopic microsurgery, relatively easy to learn, and available. Despite wide adoption of transanal minimally invasive surgery, to date only a few series on the implementation and use of this technique are reported, and detailed information on the effect of transanal minimally invasive surgery on fecal continence is not available.
  
  
  OBJECTIVE
  The purpose of this work was to prospectively assess the functional outcome after transanal minimally invasive surgery using the Fecal Incontinence Severity Index preoperatively and postoperatively.
  
  
  METHODS
  This was a prospective cohort study.
  
  
  METHODS
  The study was conducted at a large teaching hospital.
  
  
  METHODS
  Patients included those who underwent transanal minimally invasive surgery between October 2011 and September 2013.
  
  
  METHODS
  Transanal minimally invasive surgery was studied.
  
  
  METHODS
  We measured postoperative surgical and functional results.
  
  
  RESULTS
  A total of 37 patients underwent transanal minimally invasive surgery during our study period. Short-term morbidity rate was 14%, and positive resection margins were reported in 6 cases (16%); in 1 of these patients, a local recurrence was observed. Overall, there was a significant decline in preoperative and postoperative Fecal Incontinence Severity Index scores (p = 0.02), indicating an improvement in anorectal function after transanal minimally invasive surgery for patients with impaired preoperative continence. Seventeen patients (49%) had impaired continence before transanal minimally invasive surgery (mean Fecal Incontinence Severity Index score = 21). Continence improved in 15 (88%) of these patients after surgery; no change was observed in 1 patient (6%), and continence further decreased in another. In addition, 18 patients (51%) had normal preoperative continence (Fecal Incontinence Severity Index score = 0), of which 83% had no change in functionality, and continence decreased in 3.
  
  
  CONCLUSIONS
  No quality of life was measured.
  
  
  CONCLUSIONS
  Short-term functional results of transanal minimally invasive surgery for rectal polyps are excellent and comparable to functional results using the dedicated transanal endoscopic microsurgery equipment. More research on outcome after transanal minimally invasive surgery is needed to assess morbidity rates and oncologic clearance.
authors.affiliation: 1Department of Surgery, TweeSteden and St Elisabeth Hospital, Tilburg, the Netherlands 2Department of Surgery, Diakonessenhuis, Utrecht, the Netherlands.
authors.forename: Anandi H W
authors.initials: AH
authors.lastname: Schiphorst
authors.forename: Barbara S
authors.initials: BS
authors.lastname: Langenhoff
authors.forename: John
authors.initials: J
authors.lastname: Maring
authors.forename: Apollo
authors.initials: A
authors.lastname: Pronk
authors.forename: David D E
authors.initials: DD
authors.lastname: Zimmerman
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001003:Anal Canal / Q000601:surgery*; D004724:Endoscopy / Q000379:methods*; D005242:Fecal Incontinence / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D009364:Neoplasm Recurrence, Local; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D020127:Recovery of Function; D012004:Rectal Neoplasms / Q000601:surgery*; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D016896:Treatment Outcome