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Surgical Endoscopy Dec 2013Natural orifice translumenal endoscopic surgery (NOTES) is a minimally invasive operation using devices such as flexible endoscopes and linear or circular staplers.... (Comparative Study)
Comparative Study
BACKGROUND
Natural orifice translumenal endoscopic surgery (NOTES) is a minimally invasive operation using devices such as flexible endoscopes and linear or circular staplers. Nevertheless, hand-sewn anastomosis in NOTES remains challenging. This study aimed to investigate the feasibility of transrectal robotic NOTES requiring intracorporeal small intestinal anastomosis and closure of the rectal anterior wall incision in a relevant human model.
METHODS
The authors developed a flexible rectal proctoscope with a diameter of 43 mm for transrectal robotic NOTES. Small intestinal anastomosis was performed in a porcine intestinal transrectal NOTES model using two robotic arms and a camera inserted through the proctoscope and a rectal anterior wall incision. The quality of transrectal small intestinal anastomosis using the da Vinci surgical system (transrectal robotic NOTES group) was compared with that of transabdominal anastomosis using the da Vinci surgical system (transabdominal robot-assisted surgery group) and transrectal anastomosis using traditional transanal endoscopic microsurgery (TEM) instruments (TEM NOTES group). The quality of transrectal rectal anterior wall suturing in the transrectal robotic NOTES group was compared with that of the TEM NOTES group and the open surgical instruments group (open group).
RESULTS
Robotic intracorporeal suturing was performed successfully in the porcine intestine model. During small intestinal anastomosis, burst pressure in the transrectal robotic NOTES group (67.7 ± 29.3 mmHg) was similar to that in the transabdominal robot-assisted surgery group (73.3 ± 18.2 mmHg) but significantly higher than in the TEM NOTES group (20.3 ± 24.0 mmHg; p < 0.01). During rectal anterior wall suturing, the burst pressure did not differ significantly between the transrectal robotic NOTES group (149.9 ± 81.1 mmHg) and the open group (195.0 ± 60.5 mmHg).
CONCLUSIONS
The preliminary safety and efficacy of transrectal robotic NOTES was established. Further studies are required to determine the practical feasibility of this procedure.
Topics: Anastomosis, Surgical; Animals; Disease Models, Animal; Equipment Design; Feasibility Studies; Intestine, Small; Natural Orifice Endoscopic Surgery; Proctoscopes; Rectum; Robotics; Suture Techniques; Swine
PubMed: 23982644
DOI: 10.1007/s00464-013-3117-y -
Techniques in Coloproctology Aug 2013A new era has emerged in rectal cancer surgery--transanal total mesorectal excision (TME). Various platforms have been used to facilitate this novel approach, including... (Review)
Review
A new era has emerged in rectal cancer surgery--transanal total mesorectal excision (TME). Various platforms have been used to facilitate this novel approach, including transanal minimally invasive surgery (TAMIS) and transanal endoscopic microsurgery. We have previously reported the use of TAMIS-TME. This is a report of the first human case of robotic-assisted transanal surgery for TME.
Topics: Adenocarcinoma; Anal Canal; Female; Follow-Up Studies; Humans; Immunohistochemistry; Magnetic Resonance Imaging; Microsurgery; Middle Aged; Minimally Invasive Surgical Procedures; Neoplasm Invasiveness; Neoplasm Staging; Preoperative Care; Proctoscopes; Proctoscopy; Rectal Neoplasms; Robotics; Tomography, X-Ray Computed; Treatment Outcome
PubMed: 23801366
DOI: 10.1007/s10151-013-1039-2 -
World Journal of Gastroenterology Apr 2013To assess the therapeutic value of endoscopic mucosal resection (EMR) under micro-probe ultrasound guidance for rectal carcinoids less than 1 cm in diameter.
AIM
To assess the therapeutic value of endoscopic mucosal resection (EMR) under micro-probe ultrasound guidance for rectal carcinoids less than 1 cm in diameter.
METHODS
Twenty-one patients pathologically diagnosed with rectal carcinoids following colonoscopy in our hospital from January 2007 to November 2012 were included in this study. The patients consisted of 14 men and 7 women, with a mean age of 52.3 ± 12.2 years (range: 36-72 years). The patients with submucosal tumors less than 1 cm in diameter arising from the rectal and muscularis mucosa detected by micro-probe ultrasound were treated with EMR and followed up with conventional endoscopy and micro-probe ultrasound.
RESULTS
All of the 21 tumors were confirmed by micro-probe ultrasound as uniform hypoechoic masses originating from the rectal and muscularis mucosa, without invasion of muscularis propria and vessels, and less than 1 cm in diameter. EMR was successfully completed without bleeding, perforation or other complications. The resected specimens were immunohistochemically confirmed to be carcinoids. Patients were followed up for one to two years, and no tumor recurrence was reported.
CONCLUSION
EMR is a safe and effective treatment for rectal carcinoids less than 1 cm in diameter.
Topics: Adult; Aged; Aged, 80 and over; Biopsy; Carcinoid Tumor; Colonoscopy; Equipment Design; Female; Humans; Intestinal Mucosa; Intestinal Neoplasms; Male; Middle Aged; Miniaturization; Proctoscopes; Proctoscopy; Rectal Neoplasms; Time Factors; Treatment Outcome; Tumor Burden; Ultrasonography, Interventional
PubMed: 23674859
DOI: 10.3748/wjg.v19.i16.2555 -
Techniques in Coloproctology Apr 2013
Topics: Cystocele; Female; Humans; Pelvic Organ Prolapse; Proctoscopes; Proctoscopy; Rectocele; Urologic Surgical Procedures; Vagina
PubMed: 23161439
DOI: 10.1007/s10151-012-0905-7 -
Medical Physics Nov 2012To present design aspects and acceptance tests performed for clinical implementation of electronic brachytherapy treatment of early stage rectal adenocarcinoma. A...
PURPOSE
To present design aspects and acceptance tests performed for clinical implementation of electronic brachytherapy treatment of early stage rectal adenocarcinoma. A dosimetric comparison is made between the historically used Philips RT-50 unit and the newly developed Axxent(®) Model S700 electronic brachytherapy source manufactured by Xoft (iCad, Inc.).
METHODS
Two proctoscope cones were manufactured by ElectroSurgical Instruments (ESI). Two custom surface applicators were manufactured by Xoft and were designed to fit and interlock with the proctoscope cones from ESI. Dose rates, half value layers (HVL), and percentage depth dose (PDD) measurements were made with the Xoft system and compared to historical RT-50 data. A description of the patient treatment approach and exposure rates during the procedure is also provided.
RESULTS
The electronic brachytherapy system has a lower surface dose rate than the RT-50. The dose rate to water on the surface from the Xoft system is approximately 2.1 Gy∕min while the RT-50 is 10-12 Gy∕min. However, treatment times with Xoft are still reasonable. The HVLs and PDDs between the two systems were comparable resulting in similar doses to the target and to regions beyond the target. The exposure rate levels around a patient treatment were acceptable. The standard uncertainty in the dose rate to water on the surface is approximately ±5.2%.
CONCLUSIONS
The Philips RT-50 unit is an out-of-date radiotherapy machine that is no longer manufactured with limited replacement parts. The use of a custom-designed proctoscope and Xoft surface applicators allows delivery of a well-established treatment with the ease of a modern radiotherapy device. While the dose rate is lower with the use of Xoft, the treatment times are still reasonable. Additionally, personnel may stand farther away from the Xoft radiation source, thus potentially reducing radiation exposure to the operator and other personnel.
Topics: Brachytherapy; Equipment Design; Humans; Radiometry; Radiotherapy Dosage; Radiotherapy Planning, Computer-Assisted
PubMed: 23127076
DOI: 10.1118/1.4757915 -
Techniques in Coloproctology Oct 2013Following the excision of hemorrhoidal nodes during hemorrhoidectomy, intense pain is reported to be the main postoperative problem, which can last for several weeks....
Following the excision of hemorrhoidal nodes during hemorrhoidectomy, intense pain is reported to be the main postoperative problem, which can last for several weeks. Hemorrhoidopexy, an alternative treatment for hemorrhoids introduced in the late nineties, replaced hemorrhoid excision by a reduction of the hemorrhoids to their normal anatomical position, via an excision of a mucosal ring above the internal hemorrhoidal cushions. The latter excision results in minimal or no postoperative pain. In 2010, a new variant of the hemorrhoidopexy set was introduced in the European market. The variations of this set, including a detachable anvil and a lined proctoscope, aid the surgeon in performing an easier and safer hemorrhoidopexy.
Topics: Adult; Aged; Cohort Studies; Equipment Design; Female; Follow-Up Studies; Hemorrhoidectomy; Hemorrhoids; Humans; Male; Middle Aged; Minimally Invasive Surgical Procedures; Pain Measurement; Pain, Postoperative; Patient Safety; Proctoscopes; Proctoscopy; Retrospective Studies; Risk Assessment; Severity of Illness Index; Surgical Stapling; Time Factors; Treatment Outcome; Young Adult
PubMed: 23076287
DOI: 10.1007/s10151-012-0907-5 -
Colorectal Disease : the Official... Nov 2012Transanal haemorrhoidal dearterialization (THD® Doppler) is a surgical procedure involving Doppler-guided ligation of haemorrhoidal arteries to reduce arterial flow....
AIM
Transanal haemorrhoidal dearterialization (THD® Doppler) is a surgical procedure involving Doppler-guided ligation of haemorrhoidal arteries to reduce arterial flow. With proximal Doppler-guided dearterialization, arterial ligation is achieved by introducing the proctoscope completely into the anal canal and lower rectum. In the present study, distal Doppler-guided dearterialization (DDD) is performed in the distal 2 cm of the lower rectum. Immediate and short-term results were evaluated.
METHOD
One hundred patients with bleeding haemorrhoids, with or without muco-haemorrhoidal prolapse, underwent THD® Doppler procedure, using DDD of the haemorrhoidal arteries 2 cm above the anorectal junction. Mucopexy was performed in patients with haemorrhoidal prolapse.
RESULTS
The operation time was 20 ± 7 min for dearterialization alone (10 patients), and 30 ± 10 min when mucopexy was added (90 patients). Morbidity included: transient haemorrhoidal thrombosis (two patients); urinary retention (five patients); submucosal abscess (one patient). No patient complained of faecal incontinence. At a median follow-up of 7.3 (3-17) months, all patients reported an improvement in symptoms. No patients reported bleeding.
CONCLUSION
DDD of the haemorrhoidal arteries could be a simplified and more effective method of applying THD.
Topics: Anal Canal; Arteries; Hemorrhoids; Humans; Ligation; Rectum; Treatment Outcome; Ultrasonography, Doppler
PubMed: 22731786
DOI: 10.1111/j.1463-1318.2012.03146.x -
American Journal of Surgery Sep 2012Transanal endoscopic microsurgery is a safe option for proximal rectal tumors in morbidly obese patients for whom transabdominal pelvic dissection often is fraught with...
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.
Topics: Aged; Ambulatory Surgical Procedures; Anal Canal; Body Mass Index; Case-Control Studies; Endoscopy, Gastrointestinal; Female; Humans; Male; Microsurgery; Middle Aged; Obesity, Morbid; Proctoscopes; Rectal Neoplasms; Retrospective Studies
PubMed: 22578411
DOI: 10.1016/j.amjsurg.2011.11.011 -
The American Surgeon Mar 2012Doppler-guided hemorrhoidal artery ligation (DGHAL) is a nonexcisional surgical technique for the treatment of hemorrhoidal disease, consisting of the ligation of the...
Doppler-guided hemorrhoidal artery ligation (DGHAL) is a nonexcisional surgical technique for the treatment of hemorrhoidal disease, consisting of the ligation of the distal branches of the superior rectal artery, resulting in a reduction of blood flow and decongestion of hemorrhoidal plexus resulting in fibrosis. The aim of the study was to assess the efficacy and safety of DGHAL, define its indications, and identify its possible advantages and limitations for the treatment of second- and third-degree hemorrhoids. The procedure was performed using a specially designed proctoscope. The Doppler probe was used to locate all the terminal branches of hemorrhoidal arteries, which were then sutured. Patients were followed up for 2 years. From November 2006 to May 2009, 50 patients (29 female, mean age 38.2 years) underwent this procedure. The procedure was performed under local anesthesia. An average of five ligatures was placed. Average length of hospital stay was 2 hours and return to work was 2.5 days. The mean postoperative pain score was 1.72. There were no intra- or immediate postoperative major complications. In 44 patients (88%), surgery resolved the symptoms completely in a 2-year follow-up period. DGHAL is a safe and effective procedure. DGHAL can be the choice for second- and third-degree hemorrhoids with minimal postoperative pain and quick recovery.
Topics: Adult; Aged; Arteries; Comorbidity; Female; Follow-Up Studies; Hemorrhoids; Humans; Length of Stay; Ligation; Male; Middle Aged; Pain Measurement; Pain, Postoperative; Rectal Prolapse; Surgery, Computer-Assisted; Ultrasonography; Vascular Surgical Procedures; Young Adult
PubMed: 22524775
DOI: No ID Found -
Surgery Today Sep 2012This study was designed to assess the safety, efficacy, and postoperative outcomes of partial stapled hemorrhoidopexy (PSH).
PURPOSE
This study was designed to assess the safety, efficacy, and postoperative outcomes of partial stapled hemorrhoidopexy (PSH).
METHODS
A prospective study was conducted between February and March 2010. PSH was performed with single-window anoscopes for single isolated hemorrhoids, bi-window anoscopes for two isolated hemorrhoids, and tri-window anoscopes for three isolated hemorrhoids or circumferential hemorrhoids. The data pertaining to demographics, preoperative characteristics and postoperative outcomes were collected and analyzed.
RESULTS
Forty-four eligible patients underwent PSH. Single-window anoscopes were used in 2 patients, and bi- and tri-window anoscopes in 6 and 36 patients. The blood loss in patients with single-window, bi-window, and tri-window anoscopes was 6.0 ml (range 5.0-7.0 ml), 5.0 ml (range 5.0-6.5 ml), and 5.0 ml (4.5-14.5 ml) (P = 0.332). The mean postoperative visual analog scale score for pain was 3 (range, 1-4), 2 (range 1-4), 3 (range 2-6), 1 (range 0-3), 1 (range 0-2) and 2 (range 2-4) at 12 h, days 1, 2, 3, and 7, and at first defecation. The rate of urgency was 9.1%. No patients developed anal incontinence or stenosis. The 1-year recurrence rate of prolapsing hemorrhoids was 2.3%.
CONCLUSIONS
Partial stapled hemorrhoidopexy appears to be a safe and effective technique for grade III-IV hemorrhoids. Encouragingly, PSH is associated with mild postoperative pain, few urgency episodes, and no stenosis or anal incontinence.
Topics: Adult; Aged; Female; Hemorrhoids; Humans; Male; Middle Aged; Minimally Invasive Surgical Procedures; Proctoscopes; Prospective Studies; Surgical Stapling; Treatment Outcome
PubMed: 22160324
DOI: 10.1007/s00595-011-0085-5