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PubMed1982

Flexible fiberoptic sigmoidoscopy.

The 35-cm flexible fiberoptic proctosigmoidoscope is a cost-effective instrument for the family physician. Nonendoscopists have mastered its use with no reported complications. Patient tolerance is high compared to tolerance for the rigid scope. The pathology yield per procedure is two to four times greater than that reported with the rigid sigmoidoscope. Yields with the 35-cm instrument have matched those documented with the 65-cm fiberoptic instrument.

Aged↗
PubMed1993

Review: transanal endoscopic microsurgery (TEM).

Transanal endoscopic microsurgery (TEM) is performed with the use of a complex operative system, which allows the application of all surgical techniques for dissection and suturing inside the rectal cavity up to a height of 20 cm from the dentate line. Gas dilation and stereoscopic vision give an optimal overview during the procedure. In sessile adenomas and carcinomas within the region of the extraperitoneal rectum, full thickness excision is the standard procedure. The postoperative course is completely painless in all excisions at some distance from the dentate line. The complication rate is low compared with other procedures and the recurrence rate in sessile adenomas (3.5%) lower than in conventional surgery as a result of the precise dissection which is possible under the magnified stereoscopic vision. In PT1 low risk cancer we found one recurrence in 29 patients.

Adenoma↗
PubMed1994

Technique and results using the glass-rectoscope for tumour resection.

The glass-rectoscope, developed by P. Dewey is a cylinder speculum with a closed end and a working window at the side. This is a cheap instrument and method for transanal approach to the lower rectum. After preparation of the patient by saline lavage the day before operation and one dose antibiotic preoperatively, the operation is performed under general or epidural anesthesia. The digital slow dilatation of the anal sphincter is followed by introduction of the instrument, of which several versions are available. After focusing the lesion in the working window, diathermy-excision of the mucosa or of the total rectal wall is performed. Bleeding is controlled by electrocoagulation or by continuous suture of the resulting defect in the rectal wall. In 34 patients treated by transanal tumour resection, there was one local infection and four postoperative haemorrhages required operative revision by resuture. The method is suitable for removing lesions of the lower rectum up to the diameter of 2 cm and for stage T1N0 malignant lesions.

Adenocarcinoma↗
PubMed1994

Minimal invasive surgery in the local treatment of rectal cancer.

At the Surgical Department of the University of Cologne, a system has been developed for transanal endoscopic surgery, which allows all the conventional surgical techniques within the rectal cavity. The clinical and long-term results regarding local excision of broad based adenomas and small (< 4 cm) carcinomas of the rectum were the subject of the study. The main indication was the removal of sessile adenomas. Early rectal carcinomas with favourable histological grading (Grade 1 and 2) and staging (Mason I and II) were also suitable for endorectal therapeutical approach. Infiltrative cancers can be removed endoscopically in one session, but the authors performed local excisions of these cancers only in cases where the patient was unwilling to undergo extensive surgery or due to medical reasons. Nevertheless several Dukes B carcinomas were removed locally. Most of the histological findings of the subsequent radical operations (rectum resection, rectum extirpation) revealed that the carcinoma had already been totally removed. During the period July 1983 to December 1992, the techniques have been employed on 313 patients in 348 cases. Early postoperative complications consisted of intraperitoneal perforations (five cases); rectovaginal fistulae (four cases); haemorrhages (four cases), death due to cardiopulmonary failure (two cases). All the complications occurred within the first three years of the learning phase. The recurrence rate of adenomas amounted to 5%. The technique allows accurate endoscopic microsurgical excision of giant adenomas and early cancers with minimal morbidity and excellent presentation of specimens for complete histological analysis. Open invasive surgery can thus be avoided.

Adenoma↗
PubMed1994

Management of large malignant rectal polyps with transanal endoscopic microsurgery. Is there anything better for the patient?

The authors report their experience with transanal endoscopic microsurgery (TEM), a technique that allows all the standard surgical manoeuvres such as tissue excision, suction, control of bleeding and suturing in the entire length of the rectal cavity. Main indications for TEM are the removal of large sessile polyps and early rectal cancers' (T1, G1-G2). Out of 50 patients submitted to TEM the authors consider in this study 24 cases with a preoperative diagnosis of benign large sessile polyps. The procedures included: 14 (58.3%) total wall excision, four (16.6%) total wall excision with perirectal fat, three (12.5%) mucosectomy, one mucosectomy + total wall excision, one partial wall excision + total wall excision, and the remaining case was converted to laparotomy due to a large intraperitoneal perforation. There was no operative mortality and an 8.3% rate of major complications. With a median follow up of 19 months there was no evidence of local or distant recurrence. The authors compare their results with those of alternative endoscopic and surgical techniques and highlight the advantages of TEM in the management of large and giant rectal polyps.

Adenocarcinoma↗
PubMed1993

Experimental development in colorectal surgery.

A one year research programme on endoscopic colorectal resections was carried out at the University of Tübingen. Two research lines were planned: the development of the required technologies and the development of the surgical procedure. During the research programme on technologies a new device provided with an air proof system for transanal insertion of the anvil of a divisible stapler and a new technique for closure of the colonic and rectal stumps (cable binding technique) were developed. Such technological innovations enabled the authors to accomplish a new combined laparoscopic-rectoscopic procedure which was performed according to four different variants in a series of 32 animals. The last 15 consecutive successful cases, performed according to the definitive procedure, represented a standardized animal trial before starting the clinical investigation.

Anastomosis, Surgical↗