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Techniques in Coloproctology Nov 2021
Topics: Humans; Proctoscopy; Rectal Neoplasms; Transanal Endoscopic Microsurgery
PubMed: 34463878
DOI: 10.1007/s10151-021-02514-8 -
Diseases of the Colon and Rectum Jul 2024
Topics: Humans; Transanal Endoscopic Surgery; Rectal Neoplasms; Anal Canal
PubMed: 38479019
DOI: 10.1097/DCR.0000000000003200 -
Zhonghua Wei Chang Wai Ke Za Zhi =... Aug 2021Transanal total mesorectal excision (taTME) is one of the hotspots in colorectal surgery in recent years. Although most studies confirm that taTME is safe and feasible,... (Review)
Review
Transanal total mesorectal excision (taTME) is one of the hotspots in colorectal surgery in recent years. Although most studies confirm that taTME is safe and feasible, some studies still showed that the morbidity of complication and local recurrence rate of taTME were higher than traditional laparoscopic surgery. This article reviews and analyzes the short-term and long-term outcomes of taTME and the related progress of postoperative function. The results showed that there were no significant differences in the main short-term and long-term efficacy between taTME and traditional laparoscopic TME, but taTME had potential advantages in postoperative functional recovery. The results of case study after passing the learning curve suggested that taTME had better short-term and long-term efficacy. Moreover, with the maturity of taTME technology, transanal endoscopic surgery has gradually shown its advantages in the treatment of complex pelvic diseases. In the future, the application of single-port robot will further promote the development of natural orifice transluminal endoscopic colorectal surgery.
Topics: Humans; Neoplasm Recurrence, Local; Proctectomy; Rectal Neoplasms; Rectum; Transanal Endoscopic Surgery
PubMed: 34412183
DOI: 10.3760/cma.j.cn441530-20210320-00125 -
Zentralblatt Fur Chirurgie Aug 2019Transanal total mesorectal excision (TaTME) is an innovative and technically demanding surgical approach for the treatment of rectal cancer. This review summarises the... (Review)
Review
Transanal total mesorectal excision (TaTME) is an innovative and technically demanding surgical approach for the treatment of rectal cancer. This review summarises the international consensus statements on prerequisites and training requirements for safe implementation of this complex procedure. Recommendations will be discussed on the basis of the published surveys from dedicated training centres. Furthermore, experience is shared on mentored TaTME cadaveric courses (video) and an initial clinical series of 102 TaTMEs. The procedure should be performed primarily by postgraduate colorectal surgeons. Initially, a structured training program at designated training centers is mandatory. Cadaver training and proctoring are the central elements required to ensure safe implementation of TaTME in clinical practice. However, validation of TaTME training concepts needs further work. Evaluation of the first pioneering series indicates a learning phase with at least 40 operations. Above the cut-off, lower complication rates and acceptable quality of specimen are achieved. In our series, morbidity decreased significantly (Clavien-Dindo ≥ III: 29 vs. 9%). With the indication for TaTME, we find a median of 6 risk factors (4 - 8) for an unfavourable outcome after abdominal TME alone. Only high volume centres with a concentration of appropriately selected patients could aim for a proposed TaTME frequency of 20 per year. Structured training programs for TaTME are justified and must be completed before implementation in clinical practice. The case volume effect for the learning curve and individual patient selection are crucial and support the concentration of the new method in high volume centres.
Topics: Cadaver; Humans; Learning Curve; Rectal Neoplasms; Rectum; Transanal Endoscopic Surgery
PubMed: 31412418
DOI: 10.1055/a-0956-7065 -
Techniques in Coloproctology Jul 2022Transanal total mesorectal excision (TATME) is difficult to learn and can result in serious complications. Current paradigms for assessing performance and competency may...
BACKGROUND
Transanal total mesorectal excision (TATME) is difficult to learn and can result in serious complications. Current paradigms for assessing performance and competency may be insufficient. This study aims to develop and provide preliminary validity evidence for a TATME virtual assessment tool (TATME-VAT) to assess the cognitive skills necessary to safely complete TATME dissection.
METHODS
Participants from North America, Europe, Japan and China completed the test via an interactive online platform between 11/2019 and 05/2020. They were grouped into expert, experienced and novice surgeons depending on the number of independently performed TATMEs. TATME-VAT is a 24-item web-based assessment evaluating advanced cognitive skills, designed according to a blueprint from consensus guidelines. Eight items were multiple choice questions. Sixteen items required making annotations on still frames of TATME videos (VCT) and were scored using a validated algorithm derived from experts' responses. Annotation (range 0-100), multiple choice (range 0-100), and overall scores (sum of annotation and multiple-choice scores, normalized to μ = 50 and σ = 10) were reported.
RESULTS
There were significant differences between the expert, experienced, and novice groups for the annotation (p < 0.001), multiple-choice (p < 0.001), and overall scores (p < 0.001). The annotation (p = 0.439) and overall (p = 0.152) scores were similar between the experienced and novice groups. Annotation scores were higher in participants with 51 or more vs. 30-50 vs. less than 30 cases. Scores were also lower in users with a self-reported recent complication vs. those without.
CONCLUSIONS
This study describes the development of an interactive video-based virtual assessment tool for TATME dissection and provides initial validity evidence for its use.
Topics: Europe; Humans; Laparoscopy; Postoperative Complications; Proctectomy; Rectal Neoplasms; Rectum; Surgeons; Transanal Endoscopic Surgery
PubMed: 35503143
DOI: 10.1007/s10151-022-02621-0 -
Diseases of the Colon and Rectum Nov 2021A 59-year-old man underwent screening colonoscopy that identified a 2-cm rectal polyp in the posterior midline, 7 cm from the anal verge. Biopsy revealed a tubular...
A 59-year-old man underwent screening colonoscopy that identified a 2-cm rectal polyp in the posterior midline, 7 cm from the anal verge. Biopsy revealed a tubular adenoma with high-grade dysplasia. The patient underwent a robotic-assisted transanal minimally invasive surgery with full-thickness excision (Fig. 1). Final pathology confirmed a well-differentiated adenocarcinoma extending into the submucosa (sm2). There was no lymphovascular or perineural invasion, and the radial margin was 5 mm.
Topics: Adenocarcinoma; Colonoscopy; Humans; Male; Middle Aged; Neoplasm Staging; Rectal Neoplasms; Robotic Surgical Procedures; Transanal Endoscopic Surgery
PubMed: 34382598
DOI: 10.1097/DCR.0000000000002241 -
Updates in Surgery Jun 2022Robotic transanal minimally invasive surgery (R-TAMIS) is a novel and evolving technique with limited reported outcomes in the literature. Compared to the laparoscopic...
Robotic transanal minimally invasive surgery (R-TAMIS) is a novel and evolving technique with limited reported outcomes in the literature. Compared to the laparoscopic approach, R-TAMIS provides enhanced optics, increased degrees of motion, superior ergonomics, and easier maneuverability in the confines of the rectum. We report a single institution experience at a large quaternary referral academic medical center with R-TAMIS using the da Vinci Xi® platform. This is a retrospective review of electronic medical records at the Mayo Clinic from September 2017 to April 2020. It includes all available clinical documentations for patients undergoing R-TAMIS at our institution. Patient demographics, intraoperative data (procedure time, tumor size and distance), complications, and pathology reports were reviewed. A total of 28 patients underwent R-TAMIS. Median follow-up was 23.65 months. Sixteen patients underwent R-TAMIS for endoscopically unresectable rectal polyps, eight for rectal adenocarcinoma, two for rectal gastrointestinal stromal tumor, and two for rectal carcinoid tumor. The mean size of the lesions was 4.1 cm (range 0.2-13.8 cm). The mean location of lesions was 7.8 cm (range 0-16 cm) from the anal verge. The mean operative time was 132.5 ± 46.8 min. There was one 30-day complication, and no deaths. Twenty-three (82%) patients were discharged the day of surgery. R-TAMIS is a safe, feasible, and effective technique for the surgical treatment of a variety of rectal pathology. A hybrid technique can be used for the resecting tumors extending into the anal canal.
Topics: Anal Canal; Humans; Minimally Invasive Surgical Procedures; Rectal Neoplasms; Rectum; Robotic Surgical Procedures; Transanal Endoscopic Surgery
PubMed: 35175536
DOI: 10.1007/s13304-021-01233-x -
Surgical Endoscopy May 2023In the advancement of transanal local excision, robot-assisted transanal minimal invasive surgery is the newest development. In the confined area of the rectum,... (Review)
Review
BACKGROUND
In the advancement of transanal local excision, robot-assisted transanal minimal invasive surgery is the newest development. In the confined area of the rectum, robot-assisted surgery should, theoretically, be superior due to articulated utensils, video enhancement, and tremor reduction, however, this has not yet been investigated. The aim of this study was to review the evidence reported to-date on experience of using robot-assisted transanal minimal invasive surgery for treatment of rectal neoplasms.
METHODS
A comprehensive literature search of Embase and PubMed from May to August 2021were performed. Studies including patients diagnosed with rectal neoplasia or benign polyps who underwent robot-assisted transanal minimal invasive surgery were included. All studies were assessed for risk of bias through assessment tools. Main outcome measures were feasibility, excision quality, and complications.
RESULTS
Twenty-five studies with a total of 322 local excisions were included. The studies included were all retrospective, primarily case-reports, -series, and cohort studies. The median distance from the anal verge ranged from 3.5 to 10 cm and the median size was between 2.5 and 5.3 cm. Overall, 4.6% of the resections had a positive resection margin. The overall complication rate was at 9.5% with severe complications (Clavien-Dindo score III) at 0.9%.
CONCLUSION
Based on limited, retrospective data, with a high risk of bias, robot-assisted transanal minimal invasive surgery seems feasible and safe for local excisions in the rectum.
Topics: Humans; Robotics; Retrospective Studies; Feasibility Studies; Rectum; Rectal Neoplasms; Anal Canal; Transanal Endoscopic Surgery; Margins of Excision; Treatment Outcome
PubMed: 36707419
DOI: 10.1007/s00464-022-09853-z -
Surgical Oncology Aug 2022At inception, transanal total mesorectal excision (TaTME) was hypothesized to be a solution for several problems encountered in pelvic surgery, particularly for distal...
At inception, transanal total mesorectal excision (TaTME) was hypothesized to be a solution for several problems encountered in pelvic surgery, particularly for distal rectal cancer. The transanal part of the procedure is less hampered by patient related factors such as visceral obesity and a narrow bony pelvis and can thus overcome access and visualization problems encountered with a pure abdominal approach. Clearly, as for any new technique, a learning curve needs to be negotiated, ideally without unacceptable harm to patients. In experienced hands, TaTME might overcome challenges found in anatomically challenging rectal cancer patients as well as for other indications. The role of TaTME is not to replace, but rather complement its abdominal counterpart.
Topics: Humans; Laparoscopy; Proctectomy; Rectal Neoplasms; Rectum; Transanal Endoscopic Surgery
PubMed: 34924223
DOI: 10.1016/j.suronc.2021.101695 -
Zhonghua Fu Chan Ke Za Zhi Jan 2021To evaluate the value of high-resolution anoscopy (HRA) in the diagnosis of anal precancerous lesions. A retrospective cohort study was performed, which included 142...
To evaluate the value of high-resolution anoscopy (HRA) in the diagnosis of anal precancerous lesions. A retrospective cohort study was performed, which included 142 patients who underwent HRA in vulvar and anal clinic at Obstetrics and Gynecology Hospital of Fudan University from January 2014 to December 2019. With the perianal and anal canal biopsy pathology as the "gold standard", the diagnostic value of HRA and specific findings for anal precancerous lesions were evaluated and the clinical characteristics of patients with anal precancerous lesions were analyzed. (1) Agreement between HRA and anal pathology were 76.6% (95/124, perianal) and 70.0% (84/120, anal canal), in which there was no significant difference (χ=1.365, =0.243). The strength of agreement with weighted Kappa statistic were 0.604 (perianal) and 0.455 (anal canal) respectively. HRA diagnosis were more overestimated [16.9% (21/124) in perianal and 25.0% (30/120) in anal canal] than underestimated [6.5% (8/124) in perianal and 5.0% (6/120) in anal canal]. The sensitivity and specificity of HRA in the diagnosis of anal precancerous lesions were all more than 60.0% (perianal lesions: 97.8% and 74.7%; anal canal lesions: 90.9% and 66.7%), and Youden's index were >0.5 (perianal lesions: 0.725; anal canal lesions: 0.576). The positive predictive value of HRA in anal canal lesions (50.8%) was lower than that in perianal lesions (68.8%). (2) The thin acetowhite epithelium was the most common finding in anal precancerous lesions, and its performance in anal canal lesions (the sensitivity, the specificity and the Youden's index were 78.8%, 62.4% and 0.412, respectively) were better than those in perianal lesions (the sensitivity, the specificity and the Youden's index were 28.9%, 96.9% and 0.258, respectively). The dense acetowhite epithelium and vascular patterns were only seen in anal canal lesions. Lugol's iodine was little useful for perianal lesions (the incidence of iodine negative was 0),but quite useful to evaluate the canal lesions (the positive predictive value was 83.3% and the negative predictive value was 82.3%). (3) The average age of patients with low-grade anal precancerous lesion was (37±10) years old, and high-grade anal precancerous lesion was (42±11) years old, and there was significant difference between them (=0.034). Age curve showed that the peak age was 30-40 years old. Vulvar intraepithelial lesion was the risk factor of anal precancerous lesions (χ=4.284, <0.05). HRA patterns are reliable in the diagnosis of anal precancerous lesions, which is important for guiding biopsy. However, it is easy to be overestimated, especially for anal canal lesions. The acetowhite epithelium is the most common finding in anal precancerous lesions, but vascular patterns are only seen in anal canal lesions.
Topics: Adult; Anal Canal; Anus Neoplasms; Female; Humans; Middle Aged; Precancerous Conditions; Pregnancy; Proctoscopy; Retrospective Studies
PubMed: 33486926
DOI: 10.3760/cma.j.cn112141-20200830-00679