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Minimally Invasive Therapy & Allied... Dec 2010Transanal endoscopic microsurgery (TEM) is a procedure for the treatment of rectal villous adenoma and early rectal tumours. It is actually the first single port access...
Transanal endoscopic microsurgery (TEM) is a procedure for the treatment of rectal villous adenoma and early rectal tumours. It is actually the first single port access surgery (SPA) as well as a true Natural Orifice Transluminal Endoscopic Surgery (NOTES) in standard use for the last twenty years. The use of this technique and instrumentation in cholecystectomy is revisited. A feasibility study was done on porcine model. Peri-umbilical approach with the articulated TEM instruments was used for cholecystectomy. An in vivo study was started after the successful feasibility study. Cholecystectomy was performed on three consecutive porcine models using TEM instruments. Median operation time was 26.6 min. The post-op mean wound length was 3.7 cm. One gallbladder was perforated during the operation and the others were delivered intact. The instrument length was noted and the difficulty in instrument handling was documented. SPA cholecystectomy is feasible with Transanal Endoscopic Microsurgery (TEM) instruments. The special TEM technique of manipulation within a confined space is ideal for single port surgery. The TEM rectoscope can be used as a reusable single port and the instruments can be used as well but modification is suggested.
Topics: Animals; Cholecystectomy, Laparoscopic; Equipment Design; Feasibility Studies; Humans; Microsurgery; Models, Animal; Proctoscopes; Proctoscopy; Swine; Time Factors
PubMed: 20964561
DOI: 10.3109/13645706.2010.527774 -
Journal of Visceral Surgery Jun 2010
Topics: Equipment Design; Humans; Intestinal Mucosa; Microsurgery; Proctoscopes; Proctoscopy; Rectal Neoplasms; Suture Techniques
PubMed: 20801733
DOI: 10.1016/j.jviscsurg.2010.07.006 -
Minerva Chirurgica Jun 2010Doppler-guided hemorrhoidal artery ligation (HAL Doppler) is an innovative hemorrhoid treatment mainly utilised for II-III degree where bleeding is a predominant...
AIM
Doppler-guided hemorrhoidal artery ligation (HAL Doppler) is an innovative hemorrhoid treatment mainly utilised for II-III degree where bleeding is a predominant symptom. This procedure aims at dearterialization of the internal hemorrhoidal plexus by ligation of the terminal branches of the superior rectal artery detected using a special proctoscope and ultrasound system; the procedure is performed entirely above the dentate line, so it is genuinely painless. The aim of this study was to evaluate the efficacy, safety and invasivity of HAL Doppler technique to treat II and III degree hemorrhoids.
METHODS
The authors treated 148 patients, from May 2002 to December 2007, principally affected by II-III degree hemorrhoids characterized by bleeding and pain at evacuation. These patients were examined in a retrospective observational study of 128 patients, 86% of the group. Follow-up varied from 5 up to 72 months with an average observation time of 36.5 months.
RESULTS
Success was registered in 90% of patients affected by II-III degree hemorrhoids and the absence of major complications (hemorrhage, incontinence, stenosis, perforation, sepsis).
CONCLUSION
The authors suggest the safety, efficacy and low invasity of HAL Doppler for treatment of II-III degree hemorrhoids, which also found in the literature, and highlight its use in treating patients with unhealthy conditions which are a contraindication to the usual surgical treatments. Moreover, they suppose the use of HAL Doppler in low degree hemorrhoids as a therapeutic and also prophylactic rule of advanced degree.
Topics: Adult; Aged; Arteries; Female; Hemorrhoids; Humans; Ligation; Male; Middle Aged; Retrospective Studies; Safety; Severity of Illness Index; Ultrasonography, Doppler
PubMed: 20668415
DOI: No ID Found -
International Journal of Colorectal... Sep 2010The objective was to evaluate a new method for DNA sampling from the rectal mucosa for the detection of colorectal cancer or any clinically significant pathology in the...
INTRODUCTION
The objective was to evaluate a new method for DNA sampling from the rectal mucosa for the detection of colorectal cancer or any clinically significant pathology in the colon and rectum.
METHODS
This prospective cohort study included patients scheduled for colonoscopy (group 1, n = 185) or colonic resection because of suspected colorectal cancer (group 2, n = 62). A test instrument with a balloon-holding end was introduced through a proctoscope into the rectum to collect exfoliated cells, from which DNA was isolated and quantified.
RESULTS
The detection of colorectal cancer in group 1 showed a sensitivity for the DNA cut-off levels 1.5, 2, and 2.5 microg/ml of 100%, 80%, and 60%, and a specificity of 37%, 46%, and 56%, respectively. In group 2, for the same cut-off levels, the sensitivity was 73%, 61%, and 55%, and the specificity was 67%, 67%, and 67%, respectively.
CONCLUSIONS
This novel technique is a safe and easy way of collecting DNA from the rectal mucosa. The sensitivity and specificity of the test were too low to be acceptable for a screening test. The low sensitivity and specificity in this study could be explained by the diversity within the study groups as many patients presented with long-term history of colorectal disease and surgical interventions in the past.
Topics: Colonoscopy; Colorectal Neoplasms; DNA, Neoplasm; Early Detection of Cancer; Female; Humans; Male; Middle Aged; Mucous Membrane; ROC Curve; Rectum; Sensitivity and Specificity
PubMed: 20563588
DOI: 10.1007/s00384-010-0979-5 -
International Journal of Colorectal... Oct 2010Doppler-guided haemorrhoidal artery ligation (DGHAL) is a minimally invasive surgical technique used to treat symptomatic haemorrhoids. In 2005, the DGHAL proctoscope... (Clinical Trial)
Clinical Trial
PURPOSE
Doppler-guided haemorrhoidal artery ligation (DGHAL) is a minimally invasive surgical technique used to treat symptomatic haemorrhoids. In 2005, the DGHAL proctoscope was redesigned to incorporate a window through which a recto anal repair (RAR) could be performed to improve the outcome in patients with significant prolapse symptoms. The aim of this study was to observe the outcome of a series of consecutive DGHAL-RAR procedures.
METHOD
Seventy-seven consecutive patients (49 male) underwent DGHAL-RAR for symptomatic haemorrhoids and were reviewed for a minimum of 6 months post-surgery.
RESULTS
Fifty-seven (74%) of patients presented with both prolapse and bleeding symptoms. The median number of DGHALs performed was six, and the median number of RARs was two. Most (96%) patients were discharged the same day. At follow-up, 11 patients complained of recurrent symptoms, five of prolapse, four of bleeding and two of pruritus. Eight patients suffered with post-operative anal fissures. The procedure is recommended by 84.4% of patients 6 weeks post-surgery.
CONCLUSION
DGHAL-RAR is safe, effective and well tolerated. It reduces the need for potentially dangerous excisional procedures. The RAR component is an effective addition to DGHAL in the short term for the treatment of prolapse, but longer follow-up will be required to demonstrate durability of the technique.
Topics: Adult; Equipment Design; Female; Fissure in Ano; Hemorrhage; Hemorrhoids; Humans; Ligation; Male; Middle Aged; Proctoscopes; Prolapse; Pruritus; Treatment Outcome; Ultrasonography, Interventional; Vascular Surgical Procedures
PubMed: 20411266
DOI: 10.1007/s00384-010-0951-4 -
Diseases of the Colon and Rectum May 2010Transanal hemorrhoidal dearterialization is an innovative technique to treat hemorrhoids using a specially designed proctoscope for Doppler-guided transanal ligation of...
PURPOSE
Transanal hemorrhoidal dearterialization is an innovative technique to treat hemorrhoids using a specially designed proctoscope for Doppler-guided transanal ligation of hemorrhoidal arteries. We analyzed results of experience at a single-institution with this transanal hemorrhoidal dearterialization device.
METHODS
Overall, 170 patients were submitted to transanal hemorrhoidal dearterialization during the period July 2005 through October 2008. The operation consisted of hemorrhoidal dearterialization (of 6 arteries) in all patients, with major mucosal/submucosal pexy in 56 patients (32.9%). The first consecutive 11 patients (6.4%) were treated under general/spinal anesthesia, the remaining 159 (93.6%) by sedation with propofol, supported by analgesia with remifentanil. Following transanal hemorrhoidal dearterialization surgery, patients were regularly evaluated at 2 weeks, 1 and 3 months, and once a year after operation.
RESULTS
The mean age of the 170 patients was 47.3 +/- 13.0 years; 102 (60%) were men. Hemorrhoidal disease was grade II in 13 (7.6%); grade III in 141 (82.7%), and grade IV in 16 (9.6%). Postoperative bleeding requiring surgical hemostasis occurred in 2 cases (1.2%). Mean follow-up was 11.5 +/- 12 (range, 1-41) months. Hemorrhoidal thrombosis occurred in 4 patients (2.3%), chronic pain and fecal incontinence in none. Hemorrhoidal prolapse was reported at follow-up by 50 patients (29.5%), but prolapse was confirmed only in 18 (10.5%) and was mild; some patients reporting prolapse were found to have skin tags. Overall, long-term control of bleeding was obtained in 159 patients (93.5%) and control of prolapse in 152 (89.5%). Recurrence of hemorrhoidal disease requiring surgery was found in 7 patients (4.1%).
CONCLUSIONS
Transanal hemorrhoidal dearterialization appears to be a very effective minimally invasive option to treat hemorrhoids and can be performed in a day-surgery setting. Future controlled trials comparing transanal hemorrhoidal dearterialization with other procedures will show the real potential of transanal hemorrhoidal dearterialization and define adequate indications for this approach.
Topics: Anal Canal; Chi-Square Distribution; Female; Hemorrhoids; Hemostasis, Surgical; Humans; Male; Middle Aged; Minimally Invasive Surgical Procedures; Patient Satisfaction; Postoperative Complications; Statistics, Nonparametric; Treatment Outcome; Ultrasonography, Interventional
PubMed: 20389215
DOI: 10.1007/DCR.0b013e3181cdafa7 -
Studies in Health Technology and... 2009The treatment of patient with relapse of bleeding after application of minimally invasive treatment of hemorrhoidal disease such as elastic band ligation, cryosurgical... (Comparative Study)
Comparative Study
The treatment of patient with relapse of bleeding after application of minimally invasive treatment of hemorrhoidal disease such as elastic band ligation, cryosurgical treatment Hemorrhoidal Arterial Ligation (HAL) can be presented as serious clinical problem in patients with concomitant diseases that can be contraindication for radical surgical treatment. We compared the Simple Digital Method and standard above mentioned minimally invasive ambulatory treatment. We used special proctoscope with Doppler Flowmeter in order to identify all branches of hemorrhoidal artery in the anal canal creating graphical presentation using specially adapted software. HAL method is then used to perform ligation of hemorrhoidal artery branches. The elastic ligatures (called gummiligatures) are then applied to the piles in which most prominent flow was registered using Doppler Flowmeter. Antibiotic prophylaxis and sedation was administered preoperatively. Special computer program registered all steps. Hemorrhoidal ointments and paracetamol were used after surgical procedure. Average number of identified hemorrhoid arteries branches was six, and total duration of the procedure was in average 28 min. We compared patient treatment with our method and standard methods. In tested group we noticed significantly fewer complications (after eight days the number of complications 11% vs. 74%, p<0.001, after 15 days 3% vs. 11%: p=0.101). One year after procedure, the treatment was successful in 91.4%, or 32 out of 35 patients according to proctoscopy and Doppler Flowmeter exam. There were three patients with relapse of symptoms. In 77% of patients hat were treated with rubber bands ligation relapse occurred. Our method is significantly more successful in comparison to classical methods of ambulatory treatment and can be alternative to radical surgical treatment.
Topics: Hemorrhoids; Humans; Ligation; Outcome Assessment, Health Care; Retrospective Studies; Surveys and Questionnaires; User-Computer Interface
PubMed: 19745348
DOI: No ID Found -
Colorectal Disease : the Official... Oct 2010A modification of Doppler guided haemorrhoidal artery ligation (DGHAL) to include the addition of recto-anal repair is reported. Preliminary results of function and...
OBJECTIVE
A modification of Doppler guided haemorrhoidal artery ligation (DGHAL) to include the addition of recto-anal repair is reported. Preliminary results of function and safety of third and fourth degree haemorrhoidals are given.
METHOD
Thirty patients underwent DGHAL combined with recto-anal-repair (RAR). Each had rectal examination, anorectal manometry and Quality of Life assessment before and 3 months after the procedure.
RESULTS
Twenty-nine patients were included in the final analysis. There were three (10.34%) patients of intra-operative and one (3.45%) of postoperative bleeding. Three months after RAR (17.24%) patients with minor residual mucosal prolapse were detected, three (10.34%) patients reported residual symptoms. There was no case of recurrent bleeding. Anal manometry at 3 months after RAR was significantly lower than before the procedure (P < 0.05). One (3.45%) patient reported occasional soiling 3 months after RAR.
CONCLUSION
Recto-anal-repair is safe in treating third and fourth degree haemorrhoids with no major complications and low rate of residual disease.
Topics: Adult; Aged; Anal Canal; Anti-Inflammatory Agents, Non-Steroidal; Hemorrhoids; Humans; Ligation; Middle Aged; Pain, Postoperative; Proctoscopes; Prolapse; Quality of Life; Suture Techniques; Treatment Outcome; Ultrasonography, Doppler; Ultrasonography, Interventional
PubMed: 19674029
DOI: 10.1111/j.1463-1318.2009.02034.x -
Cirugia Espanola Aug 2009We present a new technique for the surgical treatment of haemorrhoids, consisting of the repositioning of haemorrhoid cluster, using a rotating Proctoscope called Hemor...
INTRODUCTION
We present a new technique for the surgical treatment of haemorrhoids, consisting of the repositioning of haemorrhoid cluster, using a rotating Proctoscope called Hemor Pex System((R)) (HPS). This procedure is performed as an outpatient procedure, with minimal postoperative pain and rapid integration into working life.
OBJECTIVES
To present the experience with this technique during 3 years of follow up in two institutions in Genoa, Italy.
PATIENTS AND METHODS
from January 2003 to June 2006, 1112 patients with grade II, III and IV haemorrhoids were operated on using the HPS technique, in two different hospitals. Prospectively analyzed the following parameters: postoperative pain, incidence of complications and recurrence of symptoms.
RESULTS
A total of 1112 patients were operated, of whom 719 have completed the follow-up. The mean age was 47 years. In 92% of cases the intervention was performed under local anaesthesia. The average time of surgery time was 20+/-5min. A total of 97% of patients were discharged at 6h after surgery. The immediate postoperative pain, according to the Visual Analogue Scale (VAS): absent (0) in 38 cases, slight (1-3) in 431 cases, 218 medium and intense in 32 cases.
CONCLUSIONS
We believe HPS is a safe procedure, with a short learning curve for surgeons, and in particular leads to a great reduction in post-operative pain for the patient.
Topics: Adult; Aged; Aged, 80 and over; Ambulatory Surgical Procedures; Female; Hemorrhoids; Humans; Male; Middle Aged; Proctoscopes; Proctoscopy; Prospective Studies; Treatment Outcome; Young Adult
PubMed: 19540469
DOI: 10.1016/j.ciresp.2009.03.006 -
Zhongguo Yi Xue Ke Xue Yuan Xue Bao.... Apr 2009To evaluate the clinical value of diffusion weighted imaging (DWI) combined with conventional sequences of magnetic resonance imaging (T1 and T2-weighted imaging) for...
OBJECTIVE
To evaluate the clinical value of diffusion weighted imaging (DWI) combined with conventional sequences of magnetic resonance imaging (T1 and T2-weighted imaging) for the diagnosis of rectal cancer.
METHODS
DWI and conventional sequences were performed in 29 patients with endoscopically diagnosed rectal cancer and 15 patients without rectal cancer. Two doctors who were blind to the history of the patients interpreted the imaging findings. The sensitivity and specificity of conventional sequences with and without DWI were analyzed using receiver operating characteristic curve (ROC).
RESULTS
The areas under ROC were 0.915 and 0.930 for conventional sequences alone, and 0.990 and 0.994 for conventional sequences with DWI, respectively, indicating that although both of them were optimal methods for the diagnosis of rectal cancer, the accuracy of conventional sequences with DWI was significantly superior to that of conventional sequence alone (P < 0.05). The Kappa value was 0.850 for conventional sequences alone and 0.858 for DWI with conventional sequences.
CONCLUSION
DWI was necessary for the diagnosis of rectal cancer when performing conventional sequences.
Topics: Adenocarcinoma; Aged; Diffusion Magnetic Resonance Imaging; Female; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Proctoscopes; ROC Curve; Rectal Neoplasms; Sensitivity and Specificity
PubMed: 19507600
DOI: No ID Found