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At least 307 records · Page 17Linked to original sources
PubMed1992

[Minimally invasive surgery of the rectum].

Low precision of transanal techniques, their limited area of application and high rate of complications of extensive surgical techniques led to the development of an endoscopic surgical system. Its main indication is the removal of broad based adenomas and early rectal cancers. Further indications are palliative excisions of advanced cancers. From July 1983 till December 1990 the endoscopic system has been employed on 233 patients. The total sum of operations raised to 251 cases due to recurrences and new tumour formations. The overall crude 5 year survival with merely local removal of rectal cancer was 67% for early rectal carcinoma patients and 75% for patients with pT2 carcinomas. Early postoperative complications consisted of 5 intraperitoneal perforations, 4 recto-vaginal fistulas and 4 haemorrhages (complication rate 5.2%). There were 2 postoperative deaths due to cardiopulmonary failure (clinical lethality 0.8%). The overall recurrence rate of adenomas was 4.9%. In accordance with the selection criterias of other authors, our selection criteria for curative local excisions of rectal cancers enclose tumour diameter less than 4 cm, pT1 carcinomas, low grade malignancy and tumour free margins of locally excised specimen.

Adult↗
PubMed1992

[Extraction of an artery in rectal biopsy].

A biopsy of a rectal carcinoma has led to the extraction of a 2.5 cm arterial specimen, followed by an arterial bleeding. The cause of this exceptional complication was the presence of atypical vessels reaching the rectal lumen due to tumor ulceration.

Adenocarcinoma↗
PubMed1992

[Endoscopic sonography of the anorectum in inflammatory rectal diseases].

213 patients, classified in 3 groups, were examined in a prospective trial using endorectal ultrasound. 80 patients (group A) had no anorectal disease, the endorectal ultrasound showed normal structures of the anorectum and the perirectal tissue. 80 patients (group B) suffered from Crohn's disease, 30 of them had no clinical signs, the rest of this group (50 patients) felt pain in the anal/perianal region. 83 patients (group C) had perianal abscesses or fistulas, Crohn's disease could be excluded. In all 64 perianal fistulas and 66 perianal abscesses were diagnosed. The results of the rectal-proctological examination were compared with endorectal ultrasound. 100% of the perianal abscesses could be recognized using endosonography. The digital-proctological examination revealed only 57% of perianal abscesses and 48% of perianal fistulas; the supralevatory abscesses couldn't be detected proctologically at all. By endorectal ultrasonography we obtained useful informations about localization and extension of the inflammatory process. From a therapeutic and prognostic view the endorectal ultrasound is a simple, practicable and useful method to investigate perianal and anorectal diseases.

Abscess↗
PubMed1992

[Local excision of rectal tumors. Indications, preoperative diagnosis, surgical technique and results].

Between January 1986 and October 1991 255 patients with rectal tumors were treated by local excision. In 239 patients local excision was performed by transanal endoscopic microsurgery, 16 tumors were removed with the retractor developed by Parks. Operative mortality was 1% in 189 local removed adenomas, complications were observed in two patients (2.1%), local recurrences in seven patients (3.7%). 66 rectal carcinomas were treated by local excision (operative mortality 1%, complication rate 3%). In one of 28 local excised "low risk" T1-carcinomas a recurrence was observed. Five of eleven local treated patients with "high risk" tumors developed a recurrence. Endosonography was of utmost importance in preoperative staging of rectal tumors. Between June 1987 and October 1991 204 patients with rectal tumors (92 sessile adenomas, 30 T1-carcinomas and 82 advanced carcinomas) were examined preoperatively by endosonography. The diagnosis of an adenoma or a T1-carcinoma was made with a sensitivity of 0.9, although no differentiation was possible between adenomas and T1-carcinomas. Results of digital examination were comparable to endosonography, under condition that digital examination was complete. Insufficient information was obtained from the endosonographic detection of lymph-node metastatic spread.

Adult↗
PubMed1991

[Results of cryosurgery in the treatment of inoperable tumor stenoses of the anus and rectum].

Inoperable tumor stenosis of anus and rectum may be treated surgically only by implantation of artificial anus. Cryosurgery proves to be a feasible alternative in order to maintain free passage of the gut. The cryoprobe is introduced through a rectoscopy under direct view. Visible tumor is touched with the tip of the cryoprobe and subsequently temperature is lowered to approximately -19 degrees C. Usually anesthesia is not required. From 1976 to 1989, 213 patients had been treated by cryosurgery in our department. In 23 cases the use of an artificial anus became inevitable afterwards.

Anus Neoplasms↗
PubMed1991

[Endosonography of the rectum].

Endorectal ultrasound is proving to be a very accurate method for the preoperative staging of cancer. The tumor penetration depth is assessed with an accuracy of more than 90% for all T stages. The preoperative endosonographic evaluation of lymph nodes is superior to other imaging modalities, being more than 80% accurate in comparison to CT and lymphoscintigraphy. It is relatively easy to perform and inexpensive compared with other imaging modalities. It has proved its influence on decision making, selection for local therapy, planning of radiotherapy and reoperation of early tumor recurrencies.

Humans↗
PubMed1991

[Transanal microsurgery].

The system for TEM consists of a rectoscope of 40 mm diameter, stereoscopic optics and up to four surgical instruments for simultaneous application. Operation is performed under automatic gas distension. Since 1983 we have operated upon 332 patients, 280 of whom were analyzed in a prospective clinical trial. The complication rate was below 10%, mortality 0.3% and the recurrence rate ot the adenomas 4%. Compared to the conventional surgical procedures, postoperative pain is significantly lower and hospital stay and rehabilitation time are shorter.

Equipment Design↗
PubMed1991

[Local excision of early stages of rectal cancer].

59 patients with rectal cancer were treated by local excision. In 17 of these patients a radical resection was performed afterwards. In one of 21 local excised "low risk" T1-carcinomas a recurrence was observed. Five of 11 local treated patients with "high risk" tumours developed a recurrence. In the group of the radically treated patients two recurrences were seen. Regarding our results the local excision of "low risk" T1-carcinomas seems to be justified, if final histological workup reveals an adequate margin of healthy tissue.

Aged↗
PubMed1991

[Status of local excision of local deep rectal cancers with curative intention].

103 cases have been analyzed retrospectively to define the indication for local extirpation of small and deep-seated rectum carcinomas with curative purpose. While pedunculated carcinomatous adenomas can be removed by endoscopic loop extraction, the non-sessile polypous carcinomas have to be radically extirpated by excision from intestinal wall resection is a promising procedure. Here, the transanal access by means of a funnel-shaped, lateral fenestrated glass speculum as introduced by Dewey yields better results than the rectotomia posterior.

Adult↗
PubMed1991

[Training program for minimally invasive surgery].

Currently 'Minimally Invasive Surgery' (MIS) is rapidly finding a widening range of applications and increasing numbers of surgical departments start with new MIS techniques. Surgical work under endoscopic control requires an intensive readjustment to operation technique bringing about new problems in training. We believe that intensive training of MIS procedures on suitable training phantoms should be a prerequisite for clinical application of MIS and therefore have established a training center for MIS in Tübingen, FRG, offering weekly hands on training courses for different procedures.

Curriculum↗
PubMed1991

[Endoluminal sonography--preoperative staging of rectal cancer].

The endoluminal sonography is a new investigation in staging rectal cancer. In a prospective series the value of the endoluminal sonography is compared with clinical staging and computed tomography. The accuracy in clinical staging, computed tomography and endoluminal sonography was 77%, 76% and 87%, respectively. The reasons for under- and overstaging and the interpretation of perirectal lymph nodes are discussed. The endoluminal sonography is an important new method evaluating the operative procedure of cancers in the lower rectum.

Adult↗
PubMed1991

[Transanal decompression procedure in acute pseudo-obstruction of the colon].

Based on 3 observations the relatively rare pseudo-obstruction of the colon is described. The pathophysiological mechanism is still unknown. In chronic or subacute cases a conservative treatment seems to be justified. However this does not apply to advanced cases or when there is threat of a colon perforation. As a possible alternative to a colostomy for transanal aseptic decompression a new intestinal tube is introduced.

Aged↗
PubMed1990

[Endoscopic laser therapy in gastroenterology--physical-technical principles and applications].

Since the mid-seventies the application of laser in gastroenterology for the treatment of haemorrhages and tumours has stood the test. At present the neodym-YAG-laser is the most important endoscopically applicable laser. The sources of laser radiation, the biophysical effects of laser and their fields of application, the technical and methodical and security-technical aspects as well as own divice-technical solutions and the indications in the application of the endoscopic laser therapy are described. In 12 out of 15 patients with a villous adenoma of the rectum the treatment was successful. In 9 patients with a high-degree stenosing rectosigmoid carcinoma (diameter 0.5 cm) the passage could be restored (diameter after treatment 1.3 cm). Complications did not appear. The laser therapy is effective, poor in risks, but not cheap.

Equipment Design↗