-
Brachytherapy 2018The Papillon technique using 50-kVp soft X-rays to treat rectal adenocarcinomas was developed and clinically implemented in the 1960s. We describe differences between...
PURPOSE
The Papillon technique using 50-kVp soft X-rays to treat rectal adenocarcinomas was developed and clinically implemented in the 1960s. We describe differences between accurate dosimetry and clinical implementation of this technique that is extending from its very inception to date.
METHODS AND MATERIALS
A renaissance of the Papillon technique occurred with two recently introduced 50-kVp systems: Papillon+ by Ariane and a custom-made rectal applicator (consisting of a surface applicator inserted into a proctoscope) by iCAD's Xoft Axxent Electronic Brachytherapy (eBT) System (iCad, Inc., Sunnyvale, CA). In contrast to the initial design, we investigated the impact of introducing a plastic lid, which would provide more reproducible and more accurate dose delivery across the rectal adenocarcinoma patient population. We use both parallel-plate chamber and radiochromic film dosimeters to determine differences in basic dosimetry characteristics (beam half-value layers, outputs, percent depth doses, and profiles) between the Xoft Electronic Brachytherapy rectal applicator system with and without the plastic lid in place.
RESULTS
Compared to the open-cone applicator, the proposed applicator with the plastic lid produces a slightly harder (more penetrating) beam quality (half-value layer of 1.4 vs. 1.3-mm Al), but with reduced output (by 33%), and a slightly broader beam with flatness not worse than 3% and symmetry not worse than 2%.
CONCLUSIONS
In addition to characterizing beam properties modified by the possible introduction of the plastic cap, we also pointed out and addressed misconceptions in the use of radiochromic films for dose measurements at low-energy photon beams.
Topics: Adenocarcinoma; Brachytherapy; Equipment Design; Film Dosimetry; Humans; Physics; Radiotherapy Dosage; Rectal Neoplasms
PubMed: 29102741
DOI: 10.1016/j.brachy.2017.09.016 -
The American Surgeon Nov 2016The Ferguson Operating Anoscope (FOA) is a surgical instrument, which can facilitate transanal excision of appropriate rectal tumors within 15 cm of the anal verge....
The Ferguson Operating Anoscope (FOA) is a surgical instrument, which can facilitate transanal excision of appropriate rectal tumors within 15 cm of the anal verge. Previous work showed low recurrence (4.3%) for favorable T1 tumors (no lymphovascular invasion, well/moderate differentiation, negative margins). This follow-up study evaluates outcomes in rectal cancer excised with FOA at a tertiary care center. T1 rectal cancer patients were identified in a prospectively maintained database. Tumor pathology and patient characteristics were reviewed. Primary outcomes include tumor recurrence and patient and disease-free survival. Secondary outcomes are quality of excision (intact specimen). Twenty-eight patients had pathologic stage T1 rectal cancer (average 8 ± 2.6 cm from the anal verge). Final path demonstrated 14 per cent to be well differentiated, 82 per cent moderately differentiated, and 93 per cent without angiolymphatic invasion. All specimens removed were intact. One patient had a true local recurrence and underwent a salvage operation 24 months after her index operation. Patient survival was 96.4 per cent (n = one death from primary lung cancer) at median follow-up 64 ± 35 months. With appropriate tumor selection and quality of initial resection, FOA has demonstrated utility in achieving optimal oncologic resection of T1 rectal tumors.
Topics: Adult; Aged; Aged, 80 and over; Disease-Free Survival; Female; Follow-Up Studies; Humans; Male; Middle Aged; Neoplasm Recurrence, Local; Proctoscopes; Rectal Neoplasms; Salvage Therapy; Transanal Endoscopic Surgery; Treatment Outcome
PubMed: 28206939
DOI: No ID Found -
Deutsche Medizinische Wochenschrift... Jan 2017
Review
Topics: Colonic Diseases; Equipment Design; Humans; Proctoscopes; Proctoscopy; Rectal Diseases
PubMed: 28114721
DOI: 10.1055/s-0042-107960 -
Techniques in Coloproctology Mar 2017
Topics: Adult; Aged; Aged, 80 and over; Ambulatory Surgical Procedures; Female; Hemorrhoids; Humans; Male; Middle Aged; Postoperative Complications; Proctoscopes; Recurrence; Reoperation; Suture Techniques; Young Adult
PubMed: 28025708
DOI: 10.1007/s10151-016-1564-x -
Case Reports in Surgery 2016. In the last years many mini-invasive approaches were developed in order to reduce postoperative pain and complication after haemorrhoid surgery: one of these...
. In the last years many mini-invasive approaches were developed in order to reduce postoperative pain and complication after haemorrhoid surgery: one of these alternatives is represented by Hemorpex System, a relatively young technique that combines transanal dearterialization with mucopexy through a dedicated proctoscope. . A 78-year-old male patient was admitted to the Emergency Department for acute urinary retention and elevated temperature. Hemorpex procedure was performed 4 years before. Clinical, endoscopic, and radiological findings demonstrated the presence of multiple diverticula-like structures fulfilled by purulent fluid and a deep alteration of the normal anatomy of the rectum. He was treated following the standard protocol of acute diverticulitis and full recovery from symptoms was achieved. . Hemorpex System is a young technique, and nowadays-available studies lack long-term follow-up data. Anatomical changes induced by the procedure are consistent and definitive. Our patient luckily demonstrated a prompt response to conservative treatment, but it must be taken into account that, in case of medical treatment failure, surgical approach would be necessary and the actual patient anatomical changes could lead the surgeon to unavoidable threatening maneuvers.
PubMed: 27974987
DOI: 10.1155/2016/3298048 -
Surgical Laparoscopy, Endoscopy &... Aug 2016Transanal endoscopic surgery (TES) can be technically difficult due to the constraints of operating through a narrow proctoscope channel. In this study, we compared the... (Comparative Study)
Comparative Study
BACKGROUND
Transanal endoscopic surgery (TES) can be technically difficult due to the constraints of operating through a narrow proctoscope channel. In this study, we compared the performance of surgical novices using instruments with and without articulating shafts to perform a simulated TES task.
METHODS
Medical students each performed 10 repetitions of the Fundamentals of Laparoscopic Surgery circle-cut task. Participants were randomized into 3 groups: 2 performed the task through a TES proctoscope using scissors with either a rigid (TES-R) or articulating (TES-A) shaft. The third group performed the task laparoscopically (LAP).
RESULTS
A total of 31 medical students participated. The LAP group had a faster mean task time than both the TES-R and TES-A groups (LAP 201±120 s vs. TES-R 362±212 s and TES-A 405±212 s, both P <0.001). The TES-R group made more errors (ie, deviation from a perfect circle) than both the other groups. The TES-R group adjusted the proctoscope position during more repetitions than the TES-A group.
CONCLUSIONS
Students had faster task times when operating laparoscopically than through a TES protoscope. Task times were similar between the TES groups using scissors with articulating and rigid shafts; however, use of the articulating instruments resulted in fewer errors and less need to adjust proctoscope position.
Topics: Clinical Competence; Education, Medical, Graduate; Humans; Laparoscopy; Learning Curve; Operative Time; Proctoscopy; Simulation Training; Students, Medical
PubMed: 27380616
DOI: 10.1097/SLE.0000000000000300 -
Techniques in Coloproctology Jul 2016The aim of our study was to assess the outcome of hemorrhoidal dearterialization, achieved by a dedicated laser energy device.
BACKGROUND
The aim of our study was to assess the outcome of hemorrhoidal dearterialization, achieved by a dedicated laser energy device.
METHODS
From November 2012 to December 2014, 51 patients with second- or third-degree hemorrhoids were studied. The primary end point was a reduction in the bleeding rate; secondary end points were: postoperative complications, reduction in pain and prolapse, resolution of symptoms, and degree of patient's perception of improvement. The procedure was carried out as 1-day surgery. A diode laser device was employed to seal the terminal branches of the hemorrhoidal arteries, detected by a Doppler-equipped proctoscope. Follow-up was scheduled at 1 and 4 weeks, 3, 12, and 24 months. The rate and degree of symptoms was assessed with a four-point verbal rating scale. The rate of subjective symptomatic improvement was also evaluated with the Patient Global Improvement (PGI) Scale.
RESULTS
Mean bleeding and pain scores at baseline were 2 and 0.57. All the patients were discharged on the day of surgery. Postoperative complications were bleeding (n = 4) and external hemorrhoidal thrombosis (n = 4). Mean bleeding and pain scores at 3, 12, and 24 months were significatively reduced. After 24 months, complete resolution of bleeding was observed in 28/29 patients (96.7 %), resolution of pain in all patients, and resolution of the mucosal prolapse in 15/18 patients (76.9 %). At 12-month follow-up, 86.3 % of patients reported improvement with the PGI Scale.
CONCLUSIONS
The hemorrhoid laser procedure was effective in improving bleeding and pain symptoms in patients with grade II and III hemorrhoids.
Topics: Adolescent; Adult; Aged; Endosonography; Female; Follow-Up Studies; Gastrointestinal Hemorrhage; Hemorrhoidectomy; Hemorrhoids; Humans; Lasers, Semiconductor; Male; Middle Aged; Pain; Proctoscopy; Prolapse; Prospective Studies; Severity of Illness Index; Treatment Outcome; Ultrasonography, Doppler; Young Adult
PubMed: 27164931
DOI: 10.1007/s10151-016-1479-6 -
The American Surgeon Mar 2016Aim of this study is to assess the efficacy, safety, and long-term results of doppler-guided hemorrhoidal artery ligation procedure with a 7-year follow-up period for...
Aim of this study is to assess the efficacy, safety, and long-term results of doppler-guided hemorrhoidal artery ligation procedure with a 7-year follow-up period for treatment of grade II and III degree hemorrhoidal diseases. The procedure was performed by a specially designed proctoscope to locate and ligate all terminal branches of superior rectal artery. Patients were followed up at postoperative 1st week and 3rd, 12th, and 24th months by physical examination and 7th year by phone questionnaire using Short Form-36. Between November 2006 and May 2007, 50 patients (29 females, mean age = 38.2) underwent this procedure. All patients discharged at operation day and mean return to work was 2.5 days. There were no major complications and mean postoperative Visual Analogous Scale at first week was 1.72. At 24th month, 44 (88%) and 38 (76%) patients at 7th year were symptom free. Doppler-guided hemorrhoidal artery ligation is a safe, effective, and outpatient procedure, which can be the treatment of choice for second- and third-degree hemorrhoidal diseases with satisfactory long-term results.
Topics: Adult; Aged; Arteries; Female; Follow-Up Studies; Hemorrhoidectomy; Hemorrhoids; Humans; Ligation; Male; Middle Aged; Patient Satisfaction; Surgery, Computer-Assisted; Time Factors; Treatment Outcome; Ultrasonography, Doppler; Young Adult
PubMed: 27099057
DOI: No ID Found -
Khirurgiia 2016To compare two methods of hemorrhoid treatment. (Randomized Controlled Trial)
Randomized Controlled Trial
AIM
To compare two methods of hemorrhoid treatment.
MATERIAL AND METHODS
This prospective study included 240 patients with hemorrhoids stage III-IVA. Stages III and IVA were diagnosed in 156 (65%) and 84 (35%) patients respectively. Randomization was performed using envelopes method in one to one distribution. In group 1 (n=120) Doppler-assisted dearterialization of internal hemorrhoids with mucopexy was performed (DDM), in group 2 (n=120) - hemorrhoidectomy using harmonic scalpel (HE).
RESULTS
Duration of surgery was 17.9±6.1 and 34.5±10.1 minutes in DDM and HE groups respectively (p<0.01). Postoperative pain severity was higher in group 2 (4.8 compared with 2.5 scores of the first group (p<0.01). Narcotic analgesics were used less often in DDM group (1.3 doses compared with 6.1 doses in HE group (p<0.01). Disability period was 14.4±5.2 and 30.3±5.4 days in both groups respectively (p<0.01). Immediate postoperative complications occurred in 9 (7.5%) and 19 (15.8%) patients of DDM and HE groups respectively. Recurrent prolapse of internal hemorrhoids was diagnosed in 2 (1.7%) patients of the 1st group in terms of up to 45 days.
CONCLUSION
DDM is reliable minimally invasive method of hemorrhoids stage III-IVA treatment and has similar efficacy with HE. DDM reduces postoperative pain severity, hospital stay and disability period.
Topics: Adult; Comparative Effectiveness Research; Equipment Design; Female; Hemorrhoidectomy; Hemorrhoids; Humans; Intestinal Mucosa; Ligation; Male; Middle Aged; Minimally Invasive Surgical Procedures; Pain, Postoperative; Proctoscopes; Severity of Illness Index; Treatment Outcome; Ultrasonography, Interventional; Vascular Surgical Procedures
PubMed: 26977864
DOI: 10.17116/hirurgia2016224-28 -
Colorectal Disease : the Official... Dec 2015
Topics: Administration, Rectal; Formaldehyde; Hemorrhoids; Humans; Proctitis; Proctoscopes; Proctoscopy; Radiation Injuries
PubMed: 26382829
DOI: 10.1111/codi.13122