title: What is the best tool for transanal endoscopic microsurgery (TEM)? A case-matched study in 74 patients comparing a standard platform and a disposable material.
abstract: OBJECTIVE
  Transanal endoscopic microsurgery (TEM) is the gold standard for local excision of rectal lesions, but no study exists concerning the best material. The objective was to compare TEM using a disposable material vs a standard platform through a case-matched study.
  
  
  METHODS
  Patients who underwent TEM for rectal neoplasms were identified from prospective databases in two tertiary referral centers and matched according to four criteria (sex, tumor location, size, distance from the anal verge): TEM using a disposable material (GelPoint Applied®; group A) and TEM using a standard TEO® platform (Karl Storz, Tuttlingen, Germany; group B).
  
  
  RESULTS
  A total of 74 patients were included and divided into group A (n = 33) and group B (n = 41). Full-thickness resection was less frequent in group A (85%) than B (100%; p = 0.01). Adenocarcinoma was less frequent in group A than B: 27 vs 42% (p = 0.03). No difference was noted regarding median operative time (53 vs 53 min; p = 0.6) and a peritoneal perforation rate (6 vs 20%; p = 0.17). Median length of stay was shorter in group A than B (4 vs 5 days; p < 0.008). No significant difference was noted for major morbidity (12 vs 10%; p = 0.66), R1 resection (21 vs 10%; p = 0.2), and recurrence rates (8 vs 7%; p = 0.62). No difference was noted for rectal stenosis (3 vs 12%; p = 0.22) and transit disorder rates (12 vs 17%; p = 0.74).
  
  
  CONCLUSIONS
  Our study suggested that TEM can be performed using either a TEO® platform or a disposable material, with similar surgical results. The TEO® platform seems to be superior to obtain full-thickness and R0 resection.
authors.affiliation: Department of Digestive Surgery, Charles Nicolle Hospital, Rouen, France.|Department of Colorectal Surgery, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris VII, 100 Boulevard du Général Leclerc, 92110, Clichy, France.
authors.forename: Diane
authors.initials: D
authors.lastname: Mege
authors.affiliation: Department of Digestive Surgery, Charles Nicolle Hospital, Rouen, France.
authors.forename: Valérie
authors.initials: V
authors.lastname: Bridoux
authors.affiliation: Department of Colorectal Surgery, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris VII, 100 Boulevard du Général Leclerc, 92110, Clichy, France.
authors.forename: Léon
authors.initials: L
authors.lastname: Maggiori
authors.affiliation: Department of Digestive Surgery, Charles Nicolle Hospital, Rouen, France.
authors.forename: Jean-Jacques
authors.initials: JJ
authors.lastname: Tuech
authors.affiliation: Department of Colorectal Surgery, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris VII, 100 Boulevard du Général Leclerc, 92110, Clichy, France. yves.panis@aphp.fr.
authors.forename: Yves
authors.initials: Y
authors.lastname: Panis
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004209:Disposable Equipment; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012004:Rectal Neoplasms / Q000601:surgery; D000067369:Transanal Endoscopic Microsurgery / Q000295:instrumentation*; D016896:Treatment Outcome
keywords: Local excision; Peritoneal perforation; Rectal lesion; Transanal endoscopic microsurgery