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Eelco J. R. De Graaf - One of the best experts on this subject based on the ideXlab platform.
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colorectal surgeons learning curve of Transanal Endoscopic Microsurgery
Surgical Endoscopy and Other Interventional Techniques, 2013Co-Authors: Renee M Barendse, Marcel G W Dijkgraaf, Ursula Rolf, Arnold B Bijnen, Esther C J Consten, C Hoff, Evelien Dekker, P Fockens, Willem A Bemelman, Eelco J. R. De GraafAbstract:Background Transanal Endoscopic Microsurgery (TEM) is a technically demanding key technique in minimally invasive rectal surgery. We investigated the learning curve of colorectal surgeons commencing with TEM.
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treatment of recurrence after Transanal Endoscopic Microsurgery tem for t1 rectal cancer
Diseases of The Colon & Rectum, 2010Co-Authors: Pascal G Doornebosch, Geert W. M. Tetteroo, Floris T J Ferenschild, Johannes H W De Wilt, Imro Dawson, Eelco J. R. De GraafAbstract:PURPOSE: The aim of this study was to evaluate the management and outcome of local recurrences after Transanal Endoscopic Microsurgery for T1 rectal cancer. METHODS: Consecutive patients who underwent Transanal Endoscopic Microsurgery for pT1 rectal cancer at a Dutch referral center (IJsselland Hospital) were registered in a prospective database. Follow-up was according to Dutch guidelines on rectal cancer, with additional rigid rectoscopy and endorectal ultrasound examinations every 3 months for the first 2 years, and every 6 months thereafter. Annual MRI of the lesser pelvis was added during the last 2 years of the study. Patients with local recurrence during follow-up were selected for individual analysis of outcome. RESULTS: Of a total of 88 patients who underwent Transanal Endoscopic Microsurgery for pT1 rectal cancer, 18 patients (20.5%) had a local recurrence. Median time to local recurrence was 10 (range, 4-50) months. Median age at diagnosis of recurrence was 74 (range, 56-84) years. Of the 18 patients, 2 did not undergo further surgery because of concomitant metastatic disease, and 16 underwent salvage surgery, without need for multivisceral resections. No postoperative mortality was observed. In 15 patients (94%), a microscopically negative excision margin was obtained; in 1 patient, the excision margin was microscopically positive. Median follow-up after salvage surgery was 20 (range, 2-112) months. One patient had a local renewal of recurrence, and 7 patients (39%) had distant metastases. At 3 years, overall survival was 31%; cancer-related survival was 58%. CONCLUSIONS: Recurrent disease after Transanal Endoscopic Microsurgery for T1 rectal cancer is a major problem. Although salvage surgery for achieving local control is feasible in most patients, survival is limited, mainly because of distant metastases. Tailoring selection of T1 rectal cancers and exploring possible adjuvant treatment strategies following salvage procedures should be the next steps toward improving survival.
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Harmonic long shears further reduce operation time in Transanal Endoscopic Microsurgery
Surgical Endoscopy, 2008Co-Authors: P. E. A. Hermsen, Ifesegun D. Ayodeji, Wim H. C. Hop, Geert W. M. Tetteroo, Eelco J. R. De GraafAbstract:Background Previous research indicates that application of 5-mm harmonic shears rather than diathermia significantly reduces operation time in Transanal Endoscopic Microsurgery (TEM). Frequently, however, additional instruments were required to complete resection. We investigated whether the new 5-mm harmonic long shears (H-LS) are better equipped for TEM compared with regular harmonic shears (HS).
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Curative resection of rectal carcinoid tumors with Transanal Endoscopic Microsurgery.
Journal of laparoendoscopic & advanced surgical techniques. Part A, 2006Co-Authors: Joost C. Peerbooms, Geert W. M. Tetteroo, Jaap L. Simons, Eelco J. R. De GraafAbstract:Background: Transanal Endoscopic Microsurgery is a minimally invasive technique for local resection of rectal tumors. Its place needs to be defined for resection of carcinoid tumors of the rectum. Materials and Methods: From 1998 to 2004, rectal carcinoid tumors were diagnosed in 5 patients. The diagnosis was suggested at biopsy in all patients. All tumors were resected full thickness with Transanal Endoscopic Microsurgery. Data were obtained retrospectively from a review of hospital charts. Results: At the time of operation all tumors were small without clinical or biochemical signs of metastasis. All resected tumors were highly differentiated and had free margins without invasion into the submucosa. Operative times ranged from 15 to 35 minutes. Hospital stays ranged from 2 to 4 days. No morbidity or mortality was observed. Follow-up ranged from 3 to 75 months. No recurrences were observed. Conclusion: Transanal Endoscopic Microsurgery is an excellent technique for removal of carcinoid tumors of the rect...
J. R. T. Monson - One of the best experts on this subject based on the ideXlab platform.
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quality of local excision for rectal neoplasms using Transanal Endoscopic Microsurgery versus Transanal minimally invasive surgery a multi institutional matched analysis
Diseases of The Colon & Rectum, 2017Co-Authors: Lawrence Lee, Kimberly Edwards, Iain Andrew Hunter, John E Hartley, S Atallah, Matthew R Albert, James O Hill, J. R. T. MonsonAbstract:Background There are no data comparing the quality of local excision of rectal neoplasms using Transanal Endoscopic Microsurgery and Transanal minimally invasive surgery. Objective The purpose of this study was to compare the incidence of tumor fragmentation and positive margins for patients undergoing local excision of benign and malignant rectal neoplasms using Transanal Endoscopic Microsurgery versus Transanal minimally invasive surgery. Design This was a multi-institutional cohort study using coarsened exact matching. Settings The study was conducted at high-volume tertiary institutions with specialist colorectal surgeons. Patients Patients undergoing full-thickness local excision for benign and malignant rectal neoplasms were included. Interventions Transanal Endoscopic Microsurgery and Transanal minimally invasive surgery were the included interventions. Main outcome measures The incidence of poor quality excision (composite measure including tumor fragmentation and/or positive resection margin) was measured. Results The matched cohort consisted of 428 patients (247 with Transanal Endoscopic Microsurgery and 181 with Transanal minimally invasive surgery). Transanal minimally invasive surgery was associated with shorter operative time and length of stay. Poor quality excision was similar (8% vs 11%; p = 0.233). There were also no differences in peritoneal violation (3% vs 3%; p = 0.965) and postoperative complications (11% vs 9%; p = 0.477). Cumulative 5-year disease-free survival for patients undergoing Transanal Endoscopic Microsurgery was 80% compared with 78% for patients undergoing Transanal minimally invasive surgery (log rank p = 0.824). The incidence of local recurrence for patients with malignancy who did not undergo immediate salvage surgery was 7% (8/117) for Transanal Endoscopic Microsurgery and 7% (7/94) for Transanal minimally invasive surgery (p = 0.864). Limitations All of the procedures were also performed at high-volume referral centers by specialist colorectal surgeons with slightly differing perioperative practices and different time periods. Conclusions High-quality local excision for benign and rectal neoplasms can be equally achieved using Transanal Endoscopic Microsurgery or Transanal minimally invasive surgery. The choice of operating platform for local excisions of rectal neoplasms should be based on surgeon preference, availability, and cost. See Video Abstract at http://links.lww.com/DCR/A382.
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Transanal Endoscopic Microsurgery for carcinoma of the rectum.
Surgical endoscopy, 2006Co-Authors: S. Maslekar, S. H. Pillinger, J. R. T. MonsonAbstract:Background The authors present their experience with rectal cancers managed by Transanal Endoscopic Microsurgery (TEM).
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Transanal Endoscopic Microsurgery: where are we now?
Digestive surgery, 2006Co-Authors: S. Maslekar, S. H. Pillinger, Daniel L. Beral, T.j. White, J. R. T. MonsonAbstract:Aims: This review of literature aimed to assess the role and establish the current status of Transanal Endoscopic Microsurgery (TEM) in the management of benign and malignant rectal
Lee E. Smith - One of the best experts on this subject based on the ideXlab platform.
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Complications of Transanal Endoscopic Microsurgery are rare and minor: a single institution's analysis and comparison to existing data.
Diseases of the colon and rectum, 2013Co-Authors: Anjali S. Kumar, Jasna Coralic, Kirthi Kolli, Deirdre C. Kelleher, Shafik Sidani, Lee E. SmithAbstract:BACKGROUND Transanal Endoscopic Microsurgery, a minimally invasive procedure for treatment of early-stage rectal cancer, carcinoid tumors, and adenomas, is shown to be a safe procedure with very low perioperative morbidity. OBJECTIVE We aimed to compare the outcomes of Transanal Endoscopic Microsurgery at a large volume tertiary care center with the existing literature. DESIGN We retrospectively reviewed a prospectively collected database of 325 Transanal Endoscopic Microsurgery procedures and looked for risk factors associated with complications. Indications for Transanal Endoscopic Microsurgery included rectal adenocarcinomas, adenomas, and carcinoids. SETTING Procedures were performed by a single surgeon at a large-volume tertiary care center. PATIENTS Patients were enrolled over a 20-year period, and data were collected on demographics, perioperative details, tumor characteristics, and complications. INTERVENTIONS Transanal Endoscopic Microsurgery was performed on all 325 patients. MAIN OUTCOME MEASURES Main outcome measures were urinary retention, late bleeding requiring intervention, dehiscence, peritoneal cavity entry, conversion to abdominal approach, fecal soiling, and rectovaginal fistula. RESULTS Intraoperative bleeding was associated with larger tumor size, whereas postoperative bleeding requiring intervention was not associated with any factors studied. Peritoneal cavity entry and urinary retention were more likely if the tumor was in either the anterior or lateral position in the rectum. The peritoneal cavity was entered in 9 patients, and conversion to abdominal approach occurred in 1 patient. Intraoperative bleeding, by surgeon's choice, and urinary retention, by patient's choice, were associated with a greater likelihood of admission to the inpatient ward. Fecal soiling was not reported by patients and not recorded. LIMITATIONS This study was limited because it was a retrospective analysis CONCLUSIONS Transanal Endoscopic Microsurgery is an extremely safe procedure, offering very low perioperative morbidity. The overall morbidity found in our study was 10.5%, on par with published data for large series of 21%, 7.7%, and 14.9%. In contrast, complications from radical resection are reported at 18% to 55%.
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Transanal Endoscopic Microsurgery: safe for midrectal lesions in morbidly obese patients
American Journal of Surgery, 2012Co-Authors: Anjali S. Kumar, Nandita Chhitwal, Jasna Coralic, Thomas J. Stahl, Jennifer M. Ayscue, James F. Fitzgerald, Lee E. SmithAbstract:BACKGROUND: Transanal Endoscopic Microsurgery is a safe option for proximal rectal tumors in morbidly obese patients for whom transabdominal pelvic dissection often is fraught with morbidity. METHODS: From a database of 318 patients who underwent Transanal Endoscopic Microsurgery, we report a retrospective case-control study of 9 patients with a body mass index range of 35 to 66 with sessile rectal lesions 6 to 15 cm from the anal verge who underwent Transanal Endoscopic Microsurgery. Case subjects were compared with 15 controls and matched for age, tumor type, and level of tumor. The average body mass index of controls was 30 (P < .001). By using t test analysis, perioperative outcomes (surgical time, blood loss, and hospital length of stay) and postoperative complications were compared. RESULTS: Sessile tumors were located 7 to 11 cm from the anal verge with a diameter of 1 to 4 cm. Patient and tumor factors such as age, distal tumor margin from anal verge, and tumor diameter were not significantly different between case subjects and controls. Surgical blood loss, surgical time, and hospital length of stay were not significantly different between the 2 groups. One complication occurred among the cases. No complications occurred in the control group. All patients had complete surgical resections with negative margins. CONCLUSIONS: Transanal Endoscopic Microsurgery in morbidly obese patients is a safe, feasible, and a viable alternative to low anterior resection.
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Transanal Endoscopic Microsurgery for rectal carcinoids: the largest reported United States experience
Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland, 2012Co-Authors: Anjali S. Kumar, Thomas J. Stahl, Jennifer M. Ayscue, James F. Fitzgerald, S. M. Sidani, Kirthi Kolli, Lee E. SmithAbstract:Aim Rectal carcinoids are often inadequately resected by snare excision during colonoscopy. Transanal Endoscopic Microsurgery is a minimally invasive procedure with low morbidity that offers full-thickness excision with a low rate of negative margins. It presents an excellent alternative to radical surgery for mid and proximally located lesions. We report the largest United States (US) experience in the use of Transanal Endoscopic Microsurgery for rectal carcinoids. Method Data of patients who had undergone Transanal Endoscopic Microsurgery for rectal carcinoids were prospectively collected and retrospectively analyzed. Patient and tumour characteristics, operative and perioperative details, as well as oncological outcomes were reviewed. Results Over a 12-year period, 24 patients underwent Transanal Endoscopic Microsurgery for rectal carcinoids. Of these, six (25%) were primary surgical resections and 18 (75%) were performed after incomplete snare excisions during colonoscopy. Three (17%) patients who underwent full-thickness resection after snare excision had residual tumour on histopathological examination. Negative margins were obtained in all cases. No recurrences were noted. Conclusion Transanal Endoscopic Microsurgery is effective and safe for the surgical resection of rectal carcinoids
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Transanal Endoscopic Microsurgery for Rectal Neoplasms
Gastrointestinal Endoscopy Clinics of North America, 1993Co-Authors: Lee E. SmithAbstract:Transanal Endoscopic Microsurgery is a new minimally invasive technique that allows complete excision of rectal lesions and wound closure. Large, sessile, benign neoplasms and small, superficial carcinomas may be excised by these methods.
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Transanal Endoscopic Microsurgery.
Diseases of the colon and rectum, 1992Co-Authors: Theodore J. Saclarides, Lee E. Smith, Bruce A. Orkin, Gerhard F. BuessAbstract:Transanal Endoscopic Microsurgery (TEM) has emerged as a minimally invasive means of resecting rectal tumors. Developed in Germany and now being used with increasing frequency in the United States, TEM utilizes a 40-mm operating rectoscope, which is sealed with an airtight facepiece. Carbon dioxide is constantly infused, thereby distending the rectum and maintaining visibility. A variety of instruments, such as tissue graspers, a high-frequency knife, suction, and needle holders, are inserted through the facepiece. Adenomas that are small, large, or even circumferential, as well as selected carcinomas up to 24 cm, can be removed with TEM instrumentation. The optics provide sixfold magnification, and this, combined with the constantly distended operative field, allows for a precise excision of the tumor as well as closure of the wound. For lesions in the mid and upper rectum, TEM is an alternative to a transsacral or transabdominal approach, with subsequently shorter hospital stay and fewer complications.
Peter A Cataldo - One of the best experts on this subject based on the ideXlab platform.
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Transanal Endoscopic Microsurgery for Early Rectal Cancer: A Single-Center Experience.
Diseases of the colon and rectum, 2017Co-Authors: Conor H. O’neill, Jesse Moore, Joseph Platz, Peter W. Callas, Peter A CataldoAbstract:BACKGROUND There is debate regarding the appropriate use of Transanal Endoscopic Microsurgery for rectal cancer. OBJECTIVE This study analyzed our single-center experience with Transanal Endoscopic Microsurgery for early rectal cancer. DESIGN Medical charts of patients who underwent Transanal Endoscopic Microsurgery were reviewed to determine lesion characteristics, as well as operative and treatment characteristics. Complications and recurrences were recorded. SETTINGS The study was conducted at a single academic medical center. PATIENTS Patients with early stage cancer (T1 or T2, N0, and M0) of the rectum were included. MAIN OUTCOME MEASURES Local and overall recurrence and disease-specific survival were measured. RESULTS A total of 92 patients were analyzed. Median follow-up was 4.6 years. Negative margins were obtained in 98.9%. Length of stay was 1 day for 95.4% of patients. The complication rate was 10.9% (n = 10), including urinary retention at 4.3% (n = 4) and postoperative bleeding at 4.3% (n = 4). Preoperative staging included 54 at T1 (58.7%) and 38 at T2 (41.3%). Adjuvant therapy was recommended for all of the T2 and select T1 lesions with adverse features on histology. The final pathologic stages of tumors were ypT0 at 8.7% (n = 8), pT1 at 58.7% (n = 54), pT2 at 23.9% (n = 22), and ypT2 at 8.7% (n = 8). The 3-year local recurrence risk was 2.4% (SE = 1.7), and overall recurrence was 6.7% (SE = 2.9). There were no recurrences among patients with complete pathologic response to neoadjuvant therapy. Mean time to recurrence was 2.5 years (SD = 1.43). A total of 89.2% of patients with very low tumors underwent curative resection without a permanent stoma (33/37). The 3-year disease-specific survival rate was 98.6% (95% CI, 90.4%-99.8%), and overall survival rate was 89.4% (95% CI, 79.9%-94.6%). LIMITATIONS The study was limited by its single-center retrospective experience. CONCLUSIONS Transanal Endoscopic Microsurgery provides comparable oncologic outcomes to radical resection in properly selected patients with early rectal cancer. Sphincter preservation rates approach 90% even in patients with very distal rectal cancer.
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Transanal Endoscopic Microsurgery
Seminars in Colon and Rectal Surgery, 2013Co-Authors: Charles S. Parsons, Peter A CataldoAbstract:Abstract Transanal Endoscopic Microsurgery (TEM) is a specialized form of Transanal Endoscopic surgery that utilizes an operating proctoscope, gas insufflation, specialized instrumentation, and magnified stereoscopic vision to operate on lesions that were previously deemed unresectable or unreachable by traditional Transanal techniques. Herein we present a brief overview of TEM, including the operative indications for both malignant and benign lesions, necessary equipment, operative technique, and a discussion of operative and oncologic outcomes.
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Comprar Transanal Endoscopic Microsurgery · Principles and Techniques | Cataldo, Peter A. | 9780387763972 | Springer
2009Co-Authors: Peter A Cataldo, Gerhard F. BuessAbstract:Tienda online donde Comprar Transanal Endoscopic Microsurgery · Principles and Techniques al precio 122,84 € de Cataldo, Peter A. | Buess, Gerhard F., tienda de Libros de Medicina, Libros de Cirugia - Cirugia General
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Transanal Endoscopic Microsurgery is more effective than traditional Transanal excision for resection of rectal masses
Diseases of The Colon & Rectum, 2008Co-Authors: Jesse Moore, Peter A Cataldo, Turner M Osler, Neil HymanAbstract:Purpose Transanal Endoscopic Microsurgery, developed by Buess in the 1980s, has become increasingly popular in recent years. No large studies have compared the effectiveness of Transanal Endoscopic Microsurgery with traditional Transanal excision.
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Transanal Endoscopic Microsurgery.
The Surgical clinics of North America, 2006Co-Authors: Peter A CataldoAbstract:Transanal Endoscopic Microsurgery (TEM) is a specialized type of local excision minimally invasive surgery. It utilizes high-resolution optics and Endoscopic instruments to remove both benign and malignant rectal lesions, avoiding the morbidity of larger operations. It requires specialized equipment and setup, but can be integrated into any operating room. TEM is largely used to remove unresectable polyps, but can also be used on T1N0 and select T2 rectal cancers. Recent studies suggest promising local recurrence and survival rates on carefully selected early-stage cancers.
Mario Morino - One of the best experts on this subject based on the ideXlab platform.
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does peritoneal perforation affect short and long term outcomes after Transanal Endoscopic Microsurgery
Surgical Endoscopy and Other Interventional Techniques, 2013Co-Authors: Mario Morino, Marco E. Allaix, M Caldart, Federico Famiglietti, Alberto ArezzoAbstract:Background Peritoneal perforation (PP) is frequently reported as a complication of Transanal Endoscopic Microsurgery (TEM). Nevertheless, these concerns have only rarely been addressed in the literature, with no mention of the long-term oncologic consequences of PP.
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Transanal Endoscopic Microsurgery for rectal neoplasms. How I do it.
Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract, 2012Co-Authors: Marco E. Allaix, Alberto Arezzo, Simone Arolfo, Caldart M, Fabrizio Rebecchi, Mario MorinoAbstract:Introduction Transanal Endoscopic Microsurgery (TEM) has revolutionized the technique and outcomes of Transanal surgery, becoming the standard of treatment for large sessile rectal adenomas, and may represent a possible treatment modality for early rectal cancer.
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Transanal Endoscopic Microsurgery vs. laparoscopic total mesorectal excision for T2N0 rectal cancer
Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract, 2012Co-Authors: Marco E. Allaix, Alberto Arezzo, Giuseppe Giraudo, Mario MorinoAbstract:Objective The aim was to compare Transanal Endoscopic Microsurgery (TEM) and laparoscopic resection (LR) in terms of short-term and oncologic outcomes in patients with a preoperatively diagnosed T2N0 extraperitoneal rectal cancer.
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Recurrence after Transanal Endoscopic Microsurgery for large rectal adenomas
Surgical endoscopy, 2012Co-Authors: Marco E. Allaix, Alberto Arezzo, Paola Cassoni, Federico Famiglietti, Mario MorinoAbstract:Background Transanal Endoscopic Microsurgery (TEM) has revolutionized the technique and outcome of Transanal surgery, becoming the standard of treatment for large sessile rectal adenomas. Nevertheless, only a few studies have evaluated the risk factors for local recurrence in order to recommend a “tailored” approach. The aim of this study was to identify predictor variables for recurrence after TEM to treat rectal adenoma.
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Transanal Endoscopic Microsurgery for rectal neoplasms experience of 300 consecutive cases
Diseases of The Colon & Rectum, 2009Co-Authors: Marco E. Allaix, Alberto Arezzo, M Caldart, Federico Festa, Mario MorinoAbstract:PURPOSE: Abdominal resection for rectal neoplasms is associated with significant morbidity. Local excision with retractors can be proposed only for distal rectal lesions. With this retrospective review of our prospective series of Transanal Endoscopic Microsurgery procedures, we wanted to verify the advantages of local treatment in terms of disease recurrence and complication rates. METHODS: Indications for Transanal Endoscopic Microsurgery were adenoma, early carcinoma, rectal ulcers, carcinoid tumors, gastrointestinal stromal tumors, and leiomyosarcoma apparently located in the extraperitoneal rectum. We analyzed operating time, morbidity and mortality rates, length of hospital stay, staging discrepancy, recurrence rate, and oncological outcome. RESULTS: From January 1993 to January 2007, 300 patients underwent Transanal Endoscopic Microsurgery at our institution. The mean operating time was 66 minutes. The peritoneum was inadvertently opened in 13 cases. The overall morbidity rate was 7.7%. The mean hospital stay was five days. Histology demonstrated cancer in 90 patients. At a mean follow-up of 60 months, the recurrence rate was zero in pT1, 24% in pT2, and 50% in pT3. The overall estimated five-year survival rate was 87%, and the disease-free survival rate was 82%. CONCLUSIONS: Transanal Endoscopic Microsurgery is safe and effective in the treatment of adenoma and pT1 carcinoma; it carries a lower morbidity than conventional surgery and a recurrence rate comparable to that of conventional surgery.
