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At least 253 records · Page 14Linked to original sources
PubMed2001

[A new video documentation system for rigid procto-rectoscopy].

INTRODUCTION: Disadvantages of rigid procto-rectoscope systems are the lack of sufficient visual documentation, data processing and the insufficient demonstration for educational purposes. Therefore a video documentation system for rigid procto-rectoscopy (Endovision Telecam SL) was developed. METHOD: For evaluation of the Endovision Telecam SL, the system was compared to the conventional technique over a 6-month period. RESULTS: The Endovision Telecam SL offers the advantage of flexible video-endoscopy and displays an excellent quality of documentation for rigid procto-rectoscopy. The handling of the system is slightly more time-consuming and difficult and the use is limited to cases without severe bleeding and stool contamination. CONCLUSIONS: The Endovision Telecam SL combines the advantages of flexible video-endoscopy in documentation, demonstration and data processing with the practibility of rigid instruments for procto-rectoscopy. In the present set-up the system is still limited to special indications and should be combined with conventional procedures.

Documentation↗
PubMed2003

[The importance of rectoscopy and colonoscopy in Internal Medicine].

The endoscopic examination of the large intestine can be considered today a routine examination in internal medicine. Since the introduction of flexible videoendoscopy, evaluating diseases in the distal colon using rectoscopy has become less important. Anoproctoscopy is an obligatory component for a complete colon diagnostic after a flexible ileo-colonoscopy has been performed. Colonoscopy has improved significantly the diagnosis and therapy of diseases in the large intestine since it has been introduced more than 30 years ago. By introducing modern videocolonoscopy in addition to other instruments, there is today a broad spectrum of diagnostic and therapeutic indications available. Specifically, due to its frequency and prognostic relevance, colonoscopy has become the most powerful and important procedure in the early detection and prevention of colon cancer.

Colonic Diseases↗
PubMed2007

Special anoscope for easy purse-string suture application in stapled hemorrhoidopexy.

BACKGROUND: Internal hemorrhoids and loose rectal mucosa may block exposure during the purse-string suturing in stapled hemorrhoidopexy, and this may lead to complications. MATERIALS AND METHODS: To retract the prolapsing rectal mucosa, we modified the purse-string anoscope of the PPH01 kit (Ethicon-Endosurgery, Cincinnati, OH, USA) and produced a special anoscope. The open part of the purse-string suture anoscope is covered by transparent acrylic (Orthoacryl, Dentaurum, Pforzheim, Germany). The covering had completely cylindrical outer and inner surfaces and was thin enough to let the anoscope easily rotate in the anal dilator and to let the 26 mm curved, round-bodied needle of the 2/0 polypropylene suture move in the anoscope. A window, 3 cm long and 3-4 mm wide, was opened at the angled part of the anoscope 2 cm to the tip. This special anoscope was used for the purse-string suture during the stapled hemorrhoidopexy procedure in five patients. RESULTS AND CONCLUSIONS: No postoperative complications, early or late, were encountered, and we propose that stapled hemorrhoidopexy procedure can be applied more easily by using this special anoscope.

Equipment Design↗
PubMed1997

Incremental elastic modulus--a challenge to compliance.

Rectal compliance has theoretical and practical drawbacks resulting in wide variation in the reported normal values. Slope of stress-strain relation, a measure of rectal wall stiffness (Incremental elastic modulus; IEM) may be an effective alternative. The aim of this study was to compare IEM with rectal compliance during ramp inflation. In a group of 15 normal adults [Median age 51.5 years (range 31 to 74); 11 female and 4 male], these parameters were assessed at three rates of inflation, using a proctometrogram-catheter-balloon (PCB) complex and endorectal ultrasound scanner (7 Mhz; B & K) to measure intrarectal pressure and radius respectively. IEM had a linear relation with strain (Slope 33.55; R2 = 0.9815) in contrast to compliance (R2 = 0.0088). Series elastic component (SEC), a measure of passive viscoelasticity, was rate independent elasticity [Slope 1.02 (0.98 to 1.15); P = ns] and a rate dependent viscosity (P = 0.004; One way ANOVA). Both IEM and SEC were reproducible (R = 0.985; P < 0.01). This study emphasises the importance of rectal wall viscoelastic evaluation based on stress and strain rather than compliance.

Adult↗
PubMed1997

Solo operated haemorrhoid ligator rectoscope. A report on 200 consecutive bandings.

A new solo operated haemorrhoid ligator rectoscope is described by the author. This new ligator consists of a double barreled cone, one fitting precisely inside the other. The device functions as a rectoscope to visualize the wall of the ano-rectum and at the same time the distal end of the interior barrel carries the rubber band and functions as the ligator. After the operator grasps the pile and pulls it into the barrel with a tenaculum, he discharges the band by retracting the internal barrel with a simple flick of the thumb. The tool is greatly simplified and more efficient than prior art. It is easy to operate and clean. The view through the rectoscope is clear and unobstructed. The author also reports on a retrospective analysis of his experience with 200 consecutive bandings of symptomatic internal haemorrhoids. The tool proved to be an effective way of rubberbanding haemorrhoids and similar clinical results as with other rubber band devices were attained, with the added bonus that whenever indicated the device allows for a larger amount of tissue to be banded, which may be desirable when treating mucosal prolapse.

Adult↗
PubMed2003

Combining ultrasonic dissection and the Storz operation rectoscope.

BACKGROUND: Transanal endoscopic microsurgery (TEM) allows a precise, full-thickness resection of rectal tumors anywhere within the rectum. Unfortunately, the standard TEM technique needs complex and rather expensive equipment, demands high skill, and is attended by bleeding and oozing that may be challenging. A modified TEM procedure combining the new Storz operation rectoscope and ultrasonic dissection has been developed to overcome the limitations of the original technique. METHODS: The Storz operation rectoscope features a 5-mm telescope combined with a single-monitor display. Standard laparoscopic instruments and the LCSC5 Ultracision Maniple are used for dissection and coagulation. Full-thickness resection is performed most often. Closure of the defect is accomplished by interrupted 3-0 polydoxanone sutures secured by extracorporeal slipknots. RESULTS: Altogether, 18 TEMs have been performed according to the modified technique: 9 for malignant and 9 for benign lesions. The median operating time was 92.5 min for resection of malignant lesions and 40 min for resection of benign lesions. Two postoperative complications occurred: a bleeding and a partial dehiscence. The median follow-up periods were 35 months for malignant disease and 19.5 months for benign disease. No recurrence was observed. CONCLUSION: For tumors located up to 15 cm from the anal verge, TEM with the Storz rectoscope and ultrasonic dissection is indicated. Despite the complication described, coagulation is optimal and ultrasonic scissors allow working in a fairly bloodless field. The overall costs of the equipment are significantly lower.

Adenocarcinoma↗
PubMed2003

Palliation of carcinoma of the rectum using the urologic resectoscope.

BACKGROUND: Thirty percent to 40% of patients with rectal cancer are not candidates for aggressive surgery because of distant metastases, extensive local tumor infiltration, poor general condition, or refusal of the patient. The aim of this study was to report the results of endoscopic transanal resection (ETAR) using a urologic resectoscope for the palliative treatment of rectal carcinoma. METHODS: This study included 46 consecutive patients who underwent ETAR for rectal adenocarcinoma between October 1992 and October 2000. All patients had histologically confirmed adenocarcinoma. None of the patients were candidates for curative surgery. A retrospective evaluation of the outcome of ETAR was performed. RESULTS: Forty-six consecutive patients (25 men and 21 women), with a median age of 84 years (range, 57-92 years), underwent 76 ETARs. Twenty-four patients (52%) had locally advanced rectal cancer with a tumor length of more than 5 cm. The tumor involved the anterior rectal wall in 52 ETARs. Seventeen patients (37%) required more than one procedure. Median operating time was 49 min (range, 15-120 min). The morbidity rate was 8% (n = 6); perforation of the rectum occurred in 1 patient (2%) during an iterative ETAR. The mortality rate was 2%. The median postoperative stay was 5.5 days (range, 3-16 days). Symptomatic relief was achieved in 87% of patients. Colostomy was performed in 8 cases, with a median interval of 7 months (range, 3-12 months) after the first ETAR and after a median of 2 ETARs (range, 1-3). The median survival time was 14 months (range, 0-62 months); 40 patients died. The survival rate at 1, 2, and 5 years was 54%, 31.6%, and 5%, respectively. CONCLUSION: ETAR is a simple, minimally invasive, and economic method that should be part of palliative treatment for patients with rectal carcinoma. ETAR is a useful addition to the surgeon's armamentarium in the multidisciplinary approach of advanced rectal cancer together with laser destruction, stent implantation, and external beam radiotherapy. All these treatments must be evaluated not only in term of lumen patency or stoma rate, but also from the quality of life standpoint.

Aged↗
PubMed2000

The effect of high-definition imaging on surgical task efficiency in minimally invasive surgery: an experimental comparison between three-dimensional imaging and direct vision through a stereoscopic TEM rectoscope.

BACKGROUND: In 1995, when we first used a high-definition television (HDTV) video system during a laparoscopic cholecystectomy in Tuebingen, we were surprised by the excellence of the spatial impression achieved by an image with improved resolution. Although any improvement in vision systems entails a trade-off among cost, quality, and complexity, high-definition imaging may well become an essential part of 3-D video systems. The aim of this experimental study was to assess the impact of high definition on surgical task efficiency in minimally invasive surgery and to determine whether it is preferable to use a 3-D system or a 2-D system with perfect resolution and color--for instance, HDTV or the three-chip charge-coupled device (3CCD). METHODS: We compared a 3-D video system with the vision through a stereoscopic rectoscope for transanal endoscopic microsurgery (TEM). Because its stereoscopic direct vision is not restricted to either shutter technology or video resolution, TEM optics represents the state of the art. For objective comparison, inanimate phantom models with suturing tasks were set up. The setups allowed the approach of parallel instruments as in TEM operations or via a laparoscopic approach, with oblique instruments coming laterally. Both types of procedure were carried out by highly experienced laparoscopic surgeons as well as those inexperienced in endoscopic surgery. These volunteers worked under 3-D video vision and/or TEM vision. Altogether, the model tasks were performed by 54 different persons. RESULTS: The evaluation did not show a significant (p > 0.05) difference in performance time in all models, but there was a clear trend showing the benefit of a higher resolution. CONCLUSION: We found a tendency for both endoscopically inexperienced and experienced surgeons to benefit from the use of a system with improved resolution (direct vision) rather than a 3-D shutter video system.

Efficiency↗
PubMed2005

A modified anoscope to facilitate the purse-string suture for stapled hemorrhoidopexy.

Stapled hemorrhoidopexy is an alternative method to conventional surgical procedures for third-degree hemorrhoids. It has many advantages such as less pain, faster recovery and earlier return to work. Nevertheless, many reports mentioned the persistence of postoperative pain, hemorrhage, recurrence, sphincter injury, and pelvic sepsis. The complications mostly arose during the purse-string phase of the procedure. The internal hemorrhoids and loose rectal mucosa can fill the inside of the anoscope, obstruct the operation field and restrict the maneuverability of the needle holder. To overcome this difficulty, a specially designed anoscope may be used. The purse-string anoscope of the PPH 01 kit (Ethicon Endo-Surgery, Cincinnati, USA) was modified to overcome the obstruction of the staple line by internal hemorrhoids and rectal mucosal prolapse. Stapled mucosectomy with this modified anoscope was performed in 9 patients. The surgical procedure lasted approximately 25 min and the patients healed uneventfully, even though 4 of them had been operated on by surgeons in their first attempts with stapled hemorrhoidopexy. By using a modified anoscope, ideal purse-string suturing may become easier, intraoperative time may be shortened, and the learning curve may be reduced.

Adult↗
PubMed2006

Gasless transanal endoscopic surgery for rectal adenomas and early carcinomas.

Transansal endoscopic microsurgery (TEM) allows the excision of rectal tumors but is difficult and complex. A new TEM modification simplifying the procedure and reducing its cost is required. Between 1999 and 2004, 128 patients (78 women and 50 men) underwent gasless transanal endoscopic surgery (GTES) without use of a completely closed system by means of laparoscopic equipment. Histological examination revealed 112 adenomas, including 15 with neoplastic changes (6 cases of Tis and 9 cases of T1G1G2), 12 adenocarcinomas (1 case of Tis, 8 cases of T1G1G2, and 1 case of T2G1G2) and 3 carcinoid tumors. There was no operative mortality. One patient had postoperative bleeding. Adenomas recurred in 9 patients (8.3%). The adenocarcinomas demonstrated neither local recurrences nor distal spread. GTES may be considered a safe and effective minimally invasive treatment for patients with large adenomas and early carcinomas of the rectum.

Adenoma↗
PubMed2004

[Surgical treatment of hemorrhoids].

The spectrum of procedures for hemorrhoidal disease can deal with all developmental stages if carried out in a differential way. Stapled hemorrhoidopexy is an effective supplement to actual conventional surgical procedures. Hemorrhoidectomies performed with the stapler were compared with segmental hemorrhoridectomies according to Milligan-Morgan as well as anoplasty according to Fansler-Arnold, and proved to be superior as regards complication rate, need for analgesics and operation time, stay in hospital and time off work. But despite the justified euphoria about this innovative method, its necessary limitations should not be disregarded.

Follow-Up Studies↗
PubMed2006

Mapping the rectum: spatial analysis of transanal endoscopic microsurgical outcomes using GIS technology.

Transanal endoscopic microsurgery (TEM) is a technically challenging procedure hindered by rectal anatomic constraints. To study the relationship of lesion position with performance of TEM, a novel approach of spatial analysis using Geographic Information Systems (GIS) was developed. A retrospective review was conducted on 144 consecutive TEMs, analyzing clinical, pathologic, and positional characteristics. Two- and three-dimensional maps of rectal topology were developed. GIS was used for spatial analysis, accounting for regional position and clustering of lesions. Lesions were located at a mean distance of 9.3 +/- 4.9 (SD) cm from the dentate line, with an average size of 3.1 +/- 1.4 cm. Proximal regions were associated with prolonged operative time. Regions between the rectosigmoid junction and the peritoneal reflection were associated with peritoneal breach. In spatial regression analysis, regional characteristics that were significantly associated with operative time included distance, presence of cancers, and positive margins; peritoneal breach was significantly associated with lesion size and location; conversions were associated with distance (P < 0.05). Specific knowledge of lesion size and location in the context of anatomic relationships is important for optimizing operative intervention. GIS provides a valuable tool in organizing spatial information and can be extended into clinical research topics involving the distinction of anatomic relationships.

Adenocarcinoma↗
PubMed2006

Transanal endoscopic microsurgery.

TEM has been used effectively to treat large rectal polyps and early rectal malignancy for more than 20 years in Europe. Until recently, only a few specialized centers offered TEM in the United States, where it is now gaining popularity. Many hospitals have purchased equipment and are offering TEM; however, the equipment is expensive and the learning curve is steep. Therefore, it is essential that anyone performing TEM have an adequate number of cases to develop and maintain expertise in this technique. That being said, TEM remains unique when compared with laparoscopy and other minimally invasive techniques that incorporate less invasive methods of performing old operations. TEM allows surgeons to perform operations that were impossible before the development and acceptance of this technique.

Humans↗
PubMed2006

[Transanal endoscopic microsurgery (TEM). Current situation and future expectations].

Transanal endoscopic microsurgery (TEM) uses specific equipment that allows resection of large rectal adenomas and incipient malignancies in the rectal ampulla. TEM aims to provide an alternative to conventional abdominal surgery (low anterior resection or abdominoperineal amputations), which carries not inconsiderable morbidity and mortality. Application of the technique of endoanal excision is limited by the height and extension of the lesions. In this review, the authors present their own experience with this technique and that described in the literature. The protocol for selecting candidates for TEM, their preoperative preparation, equipment, characteristics of the surgical technique, postoperative complications, and follow-up are described. The collaboration of a multidisciplinary team is essential when developing this technique. TEM-associated morbidity is low and mortality is practically nil. TEM is the technique of choice in large rectal adenomas and malignant rectal tumors in stages pT1 localized in the rectal ampulla. The frequency of recurrence is similar to that in abdominal surgery. The technique does not cause complications of urinary or sexual dysfunction and fecal incontinence is minimal. In more advances stages of rectal cancer, the results of better patient selection and future studies on the possible application of neoadjuvant therapy associated with TEM are required.

Adenoma↗
PubMedDate not supplied

Endoscopic ultrasonography in rectal carcinoid tumors: contribution to selection of therapy.

To assess the clinical value of endoscopic ultrasonography (EUS) in carcinoid tumors of the rectum, we studied endoscopic and EUS findings in five patients whose tumors were relatively small in size. Endoscopy revealed sessile or semi-pedunculated smooth elevations, with mucosa of normal appearance. The elevations ranged from 5 to 15 mm in diameter, and were yellowish to white in color. EUS failed to demonstrate a small tumor in two patients whereas in the remaining three patients, a homogeneously hypoechoic mass, which was restricted to the submucosal layer, was detected. All patients were treated by endoscopic excision or local resection of the tumor, which resulted in complete removal of the tumor. We believe that even though EUS is not efficacious in cases of very small carcinoid tumors of the rectum, it can provide clinically important information in choosing therapy.

Aged↗