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BMC Medical Education May 2023The objective of our study is to develop an effective training platform for transanal endoscopic surgery and to validate a step-by-step training program for learning the...
BACKGROUND
The objective of our study is to develop an effective training platform for transanal endoscopic surgery and to validate a step-by-step training program for learning the basic skills necessary for this approach.
METHODS
We have designed a two-part study: an experimental study (with the aim to design the training platform and the training exercises - on synthetic and biological material) and a prospective analytical study, in order to validate the training program by enrolling as participants general surgery residents and specialists, without previous experience in transanal endoscopic interventions. The performance of the participants was assessed based on the time of completion, as well as the quality of the execution.
RESULTS
We have developed three different diameter platforms (5 cm, 7.5 and 10 cm), that can be used with both the TEO and TAMIS platforms; specific exercises were developed to train different surgical skills like manipulation of tissue, cutting, dissection and suturing. Forty participants were enrolled for the validation of the proposed training program (12 young residents, 16 senior residents and 12 specialist surgeons). A statistically significant improvement of the performance time, from round to round, was observed for all participants in all exercises. The time of completion for the exercises, considering the correct technical execution, was the shortest for more experienced surgeons: specialist surgeons, followed by senior residents and young residents. The biological material exercises, that closely recreate intraoperative conditions and had more strict technical requirements, were difficult to be performed by young residents; better completion rates were seen in senior residents, while all the participants in the specialist surgeons group have completed these exercises.
CONCLUSIONS
Our training program is an effective simulation based educational model for recreating intraoperative conditions particular to transanal endoscopic surgery. The proposed step-by-step training program has demonstrated to be useful in developing the important basic skills needed for transanal endoscopic surgery and assured the progress of all the participants, regardless of their surgical experience.
Topics: Humans; Prospective Studies; Transanal Endoscopic Surgery; Surgeons; Computer Simulation; Dissection; Clinical Competence; Simulation Training
PubMed: 37170198
DOI: 10.1186/s12909-023-04296-z -
BMC Surgery Feb 2022Transanal endoscopic microsurgery (TEM) has been accepted worldwide for the treatment of local rectal lesions. We aimed to assess the efficacy and safety of TEM in the...
BACKGROUND
Transanal endoscopic microsurgery (TEM) has been accepted worldwide for the treatment of local rectal lesions. We aimed to assess the efficacy and safety of TEM in the treatment of rectal neuroendocrine tumors (RNET).
METHODS
A retrospective study of patients who had undergone TEM for RNET at our institution between December 2006 and June 2019 was performed. Demographic and tumor characteristics, operative and pathological details, complications, anal function questionnaires, and follow-up data were included.
RESULTS
A total of 144 patients was included. TEM was performed as primary excision in 54 patients, after endoscopic forceps biopsy in 57 patients, and after incomplete resection by endoscopic excision in 33 patients. The median size of all primary tumors was 0.6 cm (range, 0.3-2.0 cm), and the negative resection margin was achieved in 142 (98.6%) patients. Postoperative complications (referring to only bleeding) occurred in 3 (2.1%) patients and was successfully managed with conservative method. After a median follow-up of 75.5 months after surgery, 3 patients died of other causes, and 2 patients suffered metastasis. An anal function questionnaire was posted 24 months after TEM. Among the results, 3 (2.1%) patients complained of major low anterior resection syndrome (LARS), including 1 (0.7%) who suffered from complete incontinence, while 6 (4.2%) patients had minor LARS.
CONCLUSIONS
TEM has satisfying long-term outcomes and relatively low anal function disturbance as for the treatment of small RNET. TEM also acts as a preferred salvage treatment for incomplete endoscopic excision.
Topics: Humans; Microsurgery; Neuroendocrine Tumors; Postoperative Complications; Rectal Neoplasms; Retrospective Studies; Syndrome; Transanal Endoscopic Microsurgery; Treatment Outcome
PubMed: 35120483
DOI: 10.1186/s12893-022-01494-2 -
Minerva Surgery Aug 2021Transanal endoscopic microsurgery (TEM) is a safe procedure and the rates of intra- and postoperative complications are low. The information in the literature on the...
INTRODUCTION
Transanal endoscopic microsurgery (TEM) is a safe procedure and the rates of intra- and postoperative complications are low. The information in the literature on the management of these complications is limited, and so their importance may be either under- or overestimated (which may in turn lead to under- or overtreatment). The present article reviews the most relevant series of TEM procedures and their complications and describes various approaches to their management.
EVIDENCE ACQUISITION
A systematic review of the literature, including TEM series of more than 150 cases each. We analyzed the population characteristics, surgical variables and intraoperative and postoperative complications.
EVIDENCE SYNTHESIS
A total of 1043 records were found. After review, 1031 were excluded. The review therefore includes 12 independent cohorts of TEM procedures with a total of 4395 patients. The rate of perforation into the peritoneal cavity was 5.1%, and conversion to abdominal approach was required in 0.8% of cases. The most frequent complications were acute urinary retention (AUR, 4.9%) and rectal bleeding (2.2%). Less common complications included abscesses (0.99%) and rectovaginal fistula (0.62%). Mortality rates were low, with a mean value of 0.29%.
CONCLUSIONS
Awareness and knowledge of TEM complications and their management can play an important role in their treatment and patient safety. Here, we present a review of the most important TEM series and their complication rates and describe various approaches to their management.
Topics: Female; Humans; Postoperative Complications; Rectal Neoplasms; Transanal Endoscopic Microsurgery; Transanal Endoscopic Surgery; Treatment Outcome
PubMed: 33433070
DOI: 10.23736/S2724-5691.20.08405-9 -
Cirugia Espanola Apr 2023
Topics: Humans; Endoscopic Mucosal Resection; Robotics; Transanal Endoscopic Surgery; Rectal Neoplasms; Laparoscopy
PubMed: 35908719
DOI: 10.1016/j.cireng.2022.07.016 -
Journal of Surgical Oncology Mar 2022The aims of this study are to evaluate depression and quality of life (QOL) after laparoscopic abdominoperineal resection (LAPR) or transanal total mesorectal excision... (Observational Study)
Observational Study
INTRODUCTION
The aims of this study are to evaluate depression and quality of life (QOL) after laparoscopic abdominoperineal resection (LAPR) or transanal total mesorectal excision (TaTME) surgery in low rectal cancer (RC) patients.
METHODS
This is a prospective observational cohort study. Patients were divided into two groups: either TaTME surgery or LAPR. Psychosocial distress and QOL were assessed using a questionnaire before surgery, at 6 months postsurgery, and 12 months postsurgery. The Hospital Anxiety and Depression Scale was used to assess symptoms of anxiety and depression. The European Organization for Research and Treatment of Cancer-QOL questionnaire core was used to estimate the QOL.
RESULTS
In the TaTME group, the scores of psychosocial distress and QOL showed an obvious tendency to decrease and then recover. Meanwhile, in the LAPR group, these scores deteriorated significantly at 6 and 12 months, and the recovery was less pronounced. Multivariable analysis suggested that surgical options and tumor stage were significantly associated with psychosocial distress and QOL.
CONCLUSION
For low RC, TaTME could significantly improve patients' QOL and reduce psychological distress as compared to patients with LAPR at 12 months after surgery.
Topics: Aged; Aged, 80 and over; Cohort Studies; Depression; Female; Humans; Laparoscopy; Male; Middle Aged; Postoperative Complications; Proctectomy; Psychological Distress; Quality of Life; Rectal Neoplasms; Transanal Endoscopic Surgery
PubMed: 34750821
DOI: 10.1002/jso.26741 -
Zhonghua Wei Chang Wai Ke Za Zhi =... Aug 2021As a novel surgical technique, taTME has developed rapidly in recent years. TaTME inevitably attracts some skepticism on safety, efficacy, and indication. First, the...
As a novel surgical technique, taTME has developed rapidly in recent years. TaTME inevitably attracts some skepticism on safety, efficacy, and indication. First, the controversies over taTME are mainly reflected on the safety and effectiveness of taTME. On one hand, the increase of surgical complications, such as urethral injury, CO2 embolism, anastomotic leakage and pelvic infection, has raised concerns about the safety of taTME. Second, the poor quality of taTME specimens, the increased local recurrence rate and the impaired anal function after taTME, also make people question the effectiveness of taTME. Third, there are more or less controversies in the selection of taTME cases, surgical procedures and cost-effectiveness. However, it can not be denied that taTME has a promising future in view of both surgical theory and clinical practice. Furthermore, taTME is a relatively safe and effective supplementary surgical procedure, especially for patients with low rectal cancer. We should attach more importance to structured training for beginners and conduct high-quality clinical studies in the future development of taTME in China, so as to ensure the safe implementation of taTME and obtain high-level evidence-based medicine evidence, and then standardize the clinical practice of taTME.
Topics: Humans; Neoplasm Recurrence, Local; Proctectomy; Rectal Neoplasms; Rectum; Transanal Endoscopic Surgery
PubMed: 34412192
DOI: 10.3760/cma.j.cn.441530-20200929-00545 -
Surgical Endoscopy Dec 2023Retrorectal tumors (RRTs) are rare and often surgically excised due to the risk of malignant degeneration and compressive or obstructive symptoms. The approach for...
INTRODUCTION
Retrorectal tumors (RRTs) are rare and often surgically excised due to the risk of malignant degeneration and compressive or obstructive symptoms. The approach for excision has traditionally been based on tumor location and performed using either a transabdominal or perineal approach depending on the position of the tumor. The advent of minimally invasive surgery, however, has challenged this paradigm. Here, we determined the applicability and potential advantages of a laparoscopic transabdominal approach in a series of 23 patients with RRTs.
MATERIAL AND METHODS
We included 23 patients presenting with RRTs treated at the Surgical Gastrointestinal Unit at Hospital de Sant Pau that were registered prospectively since 1998. The preoperative evaluation consisted of colonoscopy, CT scan and/or MRI, mechanical bowel lavage, and antibiotic therapy. Signed consent was obtained from all patients for a laparoscopic transabdominal approach unless the tumor was easily accessible via a perineal approach. In case of recurrence, a transanal endoscopic microsurgery (TEM) approach was considered. Surgical details, immediate morbidity, and short- and long-term outcomes were recorded.
RESULTS
Of the 23 RRT cases evaluated, 16 patients underwent a laparoscopic transabdominal approach and 6 underwent a perineal approach. No patients required conversion to open surgery. In the laparoscopic transabdominal group, the mean operating time was 158 min, the average postoperative hospital stay was 5 days, and postoperative morbidity was 18%. Three patients had recurrent RRTs, two of the three underwent surgical reintervention. The third patient was radiologically stable and close follow-up was decided.
CONCLUSION
Our results show that laparoscopic transabdominal excision of RRT is a safe and effective technique, offering the potential advantages of less invasive access and reduced morbidity. This approach challenges the traditional paradigm of excision of these infrequent tumors based solely on tumor location and offers a viable alternative for the treatment of these infrequent tumors.
Topics: Humans; Neoplasm Recurrence, Local; Laparoscopy; Rectal Neoplasms; Colonoscopy; Transanal Endoscopic Microsurgery; Treatment Outcome
PubMed: 37798533
DOI: 10.1007/s00464-023-10448-5 -
Surgical Endoscopy Dec 2023Meta-analysis of the results of transanal total mesorectal excision (taTME) and laparoscopic TME (laTME) regarding perioperative and oncological outcomes have been... (Meta-Analysis)
Meta-Analysis
Comparing perioperative and oncological outcomes of transanal and laparoscopic total mesorectal excision for rectal cancer: a meta-analysis of randomized controlled trials and prospective studies.
INTRODUCTION
Meta-analysis of the results of transanal total mesorectal excision (taTME) and laparoscopic TME (laTME) regarding perioperative and oncological outcomes have been conducted. Due to the lack of high-quality randomized controlled trials (RCTs) and prospective studies in the included literature, the conclusions are unreliable. This study included RCTs and prospective studies for analysis to obtain more reliable conclusions.
MATERIALS AND METHODS
Systematic searches of the PubMed, Embase, and Cochrane Library databases were conducted up to June 2023. To assess the quality, the Cochrane quality assessment tool and the Newcastle-Ottawa Scale were employed. The perioperative and oncological outcomes were then analyzed. The I statistic was used to evaluate statistical heterogeneity and sensitivity analyses was conducted.
RESULTS
A total of 22 studies, comprising 5056 patients, were included in the analysis, of which 6 were RCTs and 16 were prospective studies. The conversion rate in the taTME group was significantly lower than that in the laTME group (OR 0.14, 95% CI 0.09 to 0.22, P < 0.01), and the circumferential resection margin (CRM) was longer (MD 0.99 mm, 95% CI 0.66 to 1.32 mm, P < 0.01), with a lower rate of positive CRM involvement (OR 0.68, 95% CI 0.47 to 0.97, P = 0.03). No statistically significant differences were found in terms of the operation time, intraoperative blood loss, complications, anastomotic leakage, uroschesis, obstruction, secondary operation, hospital stay, urethral injury, readmission, mortality rate within 30 days, mesorectal resection quality, number of harvested lymph nodes, distal resection margin (DRM), positive DRM, local recurrence, and distance recurrence (P > 0.05).
CONCLUSION
According to the findings of this meta-analysis, which is based on RCTs and prospective studies, taTME appears to have an advantage over laTME in terms of conversion rate and CRM involvement.
Topics: Humans; Prospective Studies; Margins of Excision; Postoperative Complications; Treatment Outcome; Transanal Endoscopic Surgery; Randomized Controlled Trials as Topic; Rectal Neoplasms; Laparoscopy; Rectum
PubMed: 37872424
DOI: 10.1007/s00464-023-10495-y -
Techniques for the extraction of high rectal foreign bodies by transanal minimally invasive surgery.Techniques in Coloproctology Mar 2021Removal of rectosigmoid retained foreign bodies (RFB) may require laparoscopy and often laparotomy. Proctoscopic extraction from the distal sigmoid colon and proximal...
Removal of rectosigmoid retained foreign bodies (RFB) may require laparoscopy and often laparotomy. Proctoscopic extraction from the distal sigmoid colon and proximal rectum can be technically difficult. Using a transanal minimally invasive surgery (TAMIS) approach, RFBs can be safely removed, avoiding an abdominal operation with associated morbidity. Patients without clinical findings concerning for acute colonic perforation undergo bedside digital rectal examination and proctoscopic attempt at removal of RFB. If unsuccessful, patients undergo rectal examination under anesthesia with proctoscopy and attempted RFB removal. If the RFB cannot be easily removed, a TAMIS port is inserted into the anal canal and pneumorectum is established. A laparoscopic camera and instruments are then used to facilitate removal of the RFB. To date, TAMIS was successful in all 10 patients with RFB requiring an operation. All patients tolerated the procedure well and were discharged to home from the postoperative recovery room. Unfortunately, none of the patients presented for follow-up visits, but there were no known complications. This technique can be considered prior to laparotomy for patients with RFBs after failed digital examination with proctoscopy.
Topics: Anal Canal; Foreign Bodies; Humans; Laparoscopy; Minimally Invasive Surgical Procedures; Rectal Neoplasms; Rectum; Transanal Endoscopic Surgery
PubMed: 33423162
DOI: 10.1007/s10151-020-02396-2 -
The Journal of International Medical... Jun 2020To determine the diagnostic accuracy of preoperative T/N stage using MRI in lower and middle rectal cancer patients and the impacts on clinical decision-making. (Observational Study)
Observational Study
BACKGROUND
To determine the diagnostic accuracy of preoperative T/N stage using MRI in lower and middle rectal cancer patients and the impacts on clinical decision-making.
PATIENTS AND METHODS
There were 354 patients recruited from May 2017 to February 2019. MRI was performed within 2 weeks before surgery. Histopathologic results were evaluated for the postoperative T/N stage and MRI diagnostic accuracy was assessed based on the postoperative histopathologic results. Accuracy, sensitivity, specificity, positive predictive value, negative predictive value, and Kappa values were used to evaluate MRI diagnostic accuracy and analysis consistency compared with postoperative histopathologic staging.
RESULTS
Overall MRI diagnostic accuracy was 78.2% and 56.8% for T1-4 and N0-2 staging. The Kappa values were 0.625 and 0.323 for T1-4 and N0-2 staging, respectively. After combination, MRI diagnostic accuracy was 85% and 69.5% for T and N staging. The Kappa values were 0.693 and 0.4 for T and N staging. The diagnostic accuracy of MRI for treatment decision-making was 79.1%.
CONCLUSION
MRI enables a highly accurate preoperative assessment of T stage but only a fairly accurate preoperative assessment of the N stage for rectal cancer with surgery. The diagnostic accuracy of MRI for treatment decision-making is promising.
Topics: Aged; Chemoradiotherapy, Adjuvant; Clinical Decision-Making; Female; Humans; Image-Guided Biopsy; Magnetic Resonance Imaging; Male; Middle Aged; Neoadjuvant Therapy; Neoplasm Staging; Practice Guidelines as Topic; Predictive Value of Tests; Preoperative Care; Proctectomy; Proctoscopy; Rectal Neoplasms; Rectum; Retrospective Studies
PubMed: 32495710
DOI: 10.1177/0300060520928685