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PubMed1993

Transanal endoscopic microsurgery using a newly designed multifunctional bipolar cutting and monopolar coagulating instrument.

In order to save time for changing instruments and minimize thermal damage in underlying tissue caused by monopolar high frequency in transanal endoscopic microsurgery (TEM), we have developed a new electrosurgical instrument, in which four functions are integrated: bipolar cutting, monopolar coagulation, suction and irrigation. The new device and the conventional monopolar knife were tested during both in vitro and in vivo experiments to compare the thermal alterations and effects on operating time. In vitro experiments demonstrated that the extent of thermal alterations created by bipolar cutting was less than in the case of monopolar cutting in the fresh porcine liver and bovine rectum. The mean severity scores for carbonization, coagulation and vacuolization in the resected mucosae obtained during in vivo animal operations by the bipolar procedure were 2.09, 2.27 and 1.36, respectively, whereas those obtained using the monopolar technique were 2.64, 2.82 and 2.36, respectively. The new device required an average operation time of 673.5 seconds, whereas the conventional setup required 701.9 seconds to resect the same diameter of rectal mucosa. Reduced operation time with the new device was mainly attributable to the reduced time needed for changing the instruments for hemostasis. The decreased thermal damage to the underlying bowel wall produced by the bipolar procedure should reduce the incidence of such operative complications in TEM (Transanal Endoscopic Microsurgery, developed in 1983 by Buess, Theis and Hutterer) as perforation, dehiscence in the suture line or post-polypectomy coagulation syndrome. By quickly switching between the multiple functions of this new device a clear operative field can always be achieved, thus decreasing operation time and bleeding.(ABSTRACT TRUNCATED AT 250 WORDS)

Anal Canal↗
PubMed1993

[Minimally invasive surgery of the colon and rectum].

In the period from 1.8.89 to 1.7.92 140 adenomas and 63 carcinomas were locally resected from the rectosigmoid area with the instruments of TEM. The mortality was 0.5%, the rate of dehiscence of the suture 9.8%. 75% of these were treated conservatively. One of the 29 patients with locally resected pTl-low risk-carcinoma developed a recurrence so far. The rate of recurrent adenomas was 1.4%. From 7.1.1992 to 24.5.1993 21 procedures in colorectal surgery were performed laparoscopically or in a combined laparoscopic transanal operation. The mortality was zero. 1 case of suture dehiscence, 2 cases of crural phlebothrombosis and 1 lesion of the left ureter were observed. The use of TEM in the combined procedure means an extension of the range of minimally invasive colorectal surgery to the lower rectum.

Adenocarcinoma↗
PubMed1993

Technique and clinical results of endorectal surgery.

At the Surgical Department of the University of Cologne, a new system has been developed for transanal endoscopic surgery that allows all the conventional surgical techniques within the entire rectal cavity. The method has been in clinical use since 1983. The main indication is the removal of sessile adenomas. Early rectal carcinomas with favorable histologic grading (grades 1 and 2) and staging (Mason I and II) are also suitable for the method. Advanced cancers can also be removed endoscopically in one session, but we perform local excisions of advanced cancers only in cases in which the patient is unwilling to undergo extensive surgery. During the period from July 1983 to December 1990, this method has been employed on 233 patients in 251 cases. The intraoperative and postoperative course of 236 (94%) operations out of 251 was free from any complications. Early postoperative complications consisted of intraperitoneal perforations (five cases), rectovaginal fistulas (four cases), hemorrhages (four cases), and death as a result of cardiopulmonary failure (two cases). The recurrence rate of adenomas is 4.9%. Endorectal surgery allows endoscopic local transanal excision of large adenomas and early cancers with minimal morbidity and excellent presentation of specimens for complete histologic analysis.

Adenoma↗
PubMed1996

[Current proctology--modern functional diagnosis].

The large majority of pathological conditions in proctology can be recognized and distinguished from each other by clinical and endoscopic means of diagnosis. Manometric and neurophysiological investigations are especially useful for understanding pathophysiology; these methods are of great clinical value whenever their results contribute to a specific concept of therapy. Functional tests are able to distinguish among the various causes of sphincteric dysfunction. Defaecography might provide the decisive hint for operative treatment for manometric investigations of the ano-rectum, balloons, perfusion tubes and microtransducers are available. In cases of incontinence, especially in females, endosonography is the investigation of choice, providing most relevant information with regard to possible surgical reconstruction of the sphincter muscle.

Anal Canal↗
PubMed1996

[Rectal prolapse--choice of procedure and minimal invasive possibilities].

Diagnostic and pathomorphological findings support the notion that external and internal rectal prolapse with and without solitary rectal ulcer are merely different stages of one and the same disease. In view of the fact that, in the last resort, the aetiology of this disease remains largely unknown, the differential approach to therapeutic decision-making makes it necessary to give careful consideration to the individual situation of the patient, age, sex, case history and current findings. Although considerably in excess of 100 different surgical techniques have been reported for the treatment of rectal prolapse, only very few have finally been accepted in practice. In very old and high-risk patients, extra-abdominal corrective procedures (Delorme's procedure, peri-anal rectosigmoidal resection) performed under spinal or peridural anaesthesia, are given preference, despite the fact that the recurrence rate and the rate of persistent incontinence is higher than that seen with transabdominal techniques. In the case of younger patients and older patients unburdened by risk factors, the trans-abdominal procedures offer better functional results and lower recurrence rates. Here, anterior and posterior rectopexy and resection of the sigmoid with rectopexy are the most widely practiced procedures. With the further development of minimal invasive surgery, laparoscopic techniques are now also available, with the aid of which anterior and posterior rectopexy and intracorporeal sigmoid resection can be performed safely and reliably. These techniques will very likely further encourage the trend towards transabdominal procedures for the correction of rectal prolapse. These operative procedures may also be indicated in selected cases, in whom conservative treatment of intussusception and/or solitary rectal ulcer has failed.

Adult↗
PubMed1996

[Technique and indications for sphincter-saving transanal resection in rectal carcinoma].

Using a transanal procedure, two different operative techniques are possible: the TEM technique (Transanal Endoscopic Microsurgery), which is more and more accepted in the world as method of choice for the local resection of adenomas and carcinomas pT1 "low risk" in the rectum and the lower sigma. The technically difficult procedure requires much experience. It should therefore only be practiced in centers to reach an acceptable number of clinical cases. In the lower third of the rectum, especially in locations close to the dentate line, the conventional transanal resection of tumours is also an adequate procedure.

Anal Canal↗
PubMed1996

[Local therapy of rectum carcinoma. A prospective follow-up study].

Local therapy of rectal carcinoma with the method of TEM was performed in 98 patients during the period from August 1, 1989 to January 31, 1994. 56 of the patients had pT1, 27 pT2, and 15 pT3 tumours. There was no lethality. The rate of complications, which required operative intervention, was 8%. No lymph node metastases were found in the specimens of the patients with pT1 tumours, who were re-resected, because the margin of the primary specimen were judged to be not free of tumour. In the specimens of the re-resected patients with pT2 carcinomas, lymph node involvement was more common than remnants of the primary tumour. Two of the patients with local therapy of pT1 low-risk carcinomas developed a recurrence so far. A secondary procedure for cure according to oncologic criteria could be performed in both cases. In selected cases the local therapy of rectal carcinoma avoids the high morbidity and mortality of the classical operation. Live quality will be improved, especially if an artificial anus can be avoided. In case of a recurrence the chance of a secondary procedure for cure is not to be underestimated.

Adult↗
PubMed1996

[10 years experiences with transanal endoscopic microsurgery. Histopathologic and clinical analysis].

The clinical and long-term results encountered from July 1983 to December 1992 are subject of this study. Contrary to other (transanal and transabdominal) surgical treatments the endorectal system permits therapeutic local excisions of large, rectal adenomas and early rectal carcinomas of the "low-risk" type within the entire rectum with minimal morbidity. A superior or comparable rate of adenoma recurrence (4.8%, n = 228) as well as a more favourable operative result (complication rate 3.9%; lethality 0.6%; n = 348) can be achieved with the transanal endoscopic microsurgery. Under palliative conditions, transanal endoscopic surgery is more effective than other conservative treatments in cases of circumscribed, non-stenotic carcinomas of the rectum. Thorough surgical training is required in order to successfully practice transanal endoscopic surgery.

Adult↗
PubMed1979

[Modified method of obtaining washings of the large intestine for determining coproantibodies and immunoglobulins in the dynamics of acute dysentery].

The study of the washings obtained during rectoscopy from the mucous membrane of the large intestine with the use of a special attachment for a rectoscope revealed that this method had a number of advantages when compared with the study of coprofiltrates; in particular, this method allowed to obtain pure secretions of the mucous membrane free of fecal admixtures and to concentrate the gamma globulin fraction. The study of the dynamics of coproantibody secretion in acute dysentery revealed that coproantibodies were most frequently detected on the second week of the disease (reaching 85.7%), while immunoglobulins occurred in the protein fraction of the washings with almost the same frequency during the whole period of the disease.

Acute Disease↗
PubMedDate not supplied

Cleaning up the act.

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Cross Infection↗
PubMed1998

[Transanal endoscopic microsurgery--experiences at the Zurich University Hospital].

The advantages of TEM (transanal endoscoic microsurgery) are minimally invasive, exact and full thickness excision of tumors in the rectum and a very low morbidity with excellent comfort for the patient. In a retrospective study all transanal endoscopic operations at Zurich University hospital in the last 5 years have been analyzed (n = 18). 11 adenomas and 5 carcinomas of the rectum have been resected with TEM (one mucosectomy, 16 full wall resections and one segmental resection of the rectum). In the group of the carcinomas there were four preoperatively known carcinomas, one T1 carcinoma was discovered postoperatively in the analyzed tissue. Among the four known carcinomas was one T1 carcinoma, two T2 carcinomas (one of them was thought to be a T1 preoperatively) and one T3 carcinoma. One patient with T2 carcinoma wanted specifically a minimally invasive procedure, the other one with T2 carcinoma was an older patient who didn't qualify for laparotomy. The patient with T3 carcinoma also had a malignant lymphoma. The operation was tolerated well by all the patients. There was one case of peritoneal perforation treated laparscopically and one case of postoperative bleeding. An incontinence of gas in one patient disappeared after 3 months. There was no adjuvant treatment in the group of the T1 carcinomas. One patient with a postoperative T2 carcinoma did not want a chemotherapy. The other two patients with T2 and T3 were polymorbid. Among the resected adenomas there was no case of recurrence. One T2 carcinoma recurred. These results show that transanal endoscopic microsurgery (TEM) is an excellent technique to treat ademomas and T1 carcinomas of the rectum with the advantages of full thickness excision under good vision, a minimal rate of recurrence and maximal patient comfort. The indications for transanal microsurgery are rare. The techically demanding operation is not always simple and should be performed in larger centers only.

Adenoma↗