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Khirurgiia 200985 patients at age of 27-68 years (44.78+/-9.02) with stage III-IV hemorrhoids were treated. Trans-anal disarterization of internal hemorrhoids under Doppler control...
85 patients at age of 27-68 years (44.78+/-9.02) with stage III-IV hemorrhoids were treated. Trans-anal disarterization of internal hemorrhoids under Doppler control with mucopexy and lifting was carried out using modified Moricorn proctoscope. Operation duration amounted 24-45 minutes (32+/-5.21). Postoperative pain syndrome amounted on average 33.2+/-0.52 mm (range 20-50 mm) on the first day and 16.5+/-0.10 (0-40 mm) during 5 days which didn't require usage of narcotic analgesics. Patients returned to labor activity after 2-4 days (2.79+/-0.81). They were investigated after 6 months after operation. Bleeding stopped in 96.5% of patients, prolapsed piles were not observed in 91.8% of patients. Repeated bleedings were not registered. Complications (perianal hematoma-like external node thrombosis) were revealed in 7 (8.2%) patients. Trans-anal disarterization of internal hemorrhoids under Doppler control with mucopexy and lifting is a safe and effective alternative to hemorrhoidectomy. This method is ideal for "one-day" hospital.
Topics: Adult; Aged, 80 and over; Ambulatory Care; Anal Canal; Female; Follow-Up Studies; Hemorrhoids; Humans; Male; Middle Aged; Pain, Postoperative; Proctoscopes; Time Factors; Treatment Outcome; Ultrasonography, Doppler
PubMed: 19365337
DOI: No ID Found -
Techniques in Coloproctology Mar 2009The combination of standard laparoscopy and specimen extraction through a natural orifice has the potential to decrease wound related complications. We describe the...
The combination of standard laparoscopy and specimen extraction through a natural orifice has the potential to decrease wound related complications. We describe the technical approach to laparoscopic sigmoidectomy in which the specimen is extracted transanally through a proctoscope. Laparoscopic-assisted sigmoidectomy with transanal specimen removal avoids an abdominal wall extraction incision and may be considered an alternative approach to conventional minimally invasive sigmoidectomy in patients with disease of the sigmoid or left colon.
Topics: Anal Canal; Colectomy; Endometriosis; Equipment Design; Female; Follow-Up Studies; Humans; Laparoscopy; Proctoscopes; Sigmoid Neoplasms; Young Adult
PubMed: 19288242
DOI: 10.1007/s10151-009-0461-y -
Diseases of the Colon and Rectum Feb 2009There are a number of alternative approaches to palliate cancers of the rectosigmoid, which may not be well tolerated or produce effective symptom relief. Therefore,...
PURPOSE
There are a number of alternative approaches to palliate cancers of the rectosigmoid, which may not be well tolerated or produce effective symptom relief. Therefore, there is a continuing need to develop alternative techniques for palliation. This paper reports our initial assessment of a new bipolar radiofrequency probe (Endoblate).
METHODS
Twelve patients with rectosigmoid tumors were treated with Endoblate during transanal endoscopic microsurgery. In ten patients, this was followed by surgical resection and two patients were treated with Endoblate alone. This study was designed to assess the technical utility of the device, immediate complications, and histologic effect.
RESULTS
There were no technical problems. In the patients who had resection of the tumor immediately after ablation (n = 10), there were no local complications evident at surgery. Histology of the resected specimens showed that, on average, 82 (range, 60-99) percent of the tumor mass was destroyed in the ablation zone. In the remaining two patients, Endoblate alone was used successfully to stop bleeding from the tumor.
CONCLUSIONS
These preliminary results illustrate the evolution and endoscopic application of bipolar radiofrequency technology. Endoblate showed potential as a useful and safe tool for the palliation of lower gastrointestinal malignancy.
Topics: Aged; Aged, 80 and over; Catheter Ablation; Colorectal Neoplasms; Female; Humans; Male; Microsurgery; Middle Aged; Palliative Care; Proctoscopes; Proctoscopy
PubMed: 19279436
DOI: 10.1007/DCR.0b013e31819a3e09 -
American Journal of Surgery Dec 2008Colonoscopic localization of rectal and rectosigmoid tumors may be inaccurate. Rigid proctosigmoidoscopy has been suggested as an adjunctive technique to accurately... (Comparative Study)
Comparative Study
BACKGROUND
Colonoscopic localization of rectal and rectosigmoid tumors may be inaccurate. Rigid proctosigmoidoscopy has been suggested as an adjunctive technique to accurately localize rectal tumors as it may alter treatment options.
METHODS
A retrospective review was performed of patients with rectal and rectosigmoid cancer from 2001 to 2006. Patients were stratified into 1 of 4 anatomic regions based on colonoscopic localization of the tumor. The distances of the tumor from the anal verge by colonoscopy were compared with distances obtained via rigid proctosigmoidoscopy.
RESULTS
Rigid proctosigmoidoscopy localization likely changed the treatment options in 21% of lower rectal tumors, 14% of middle rectal tumors, 38% of upper rectal tumors, and 29% of rectosigmoid tumors. Overall, this modality impacted 25% of patients.
CONCLUSIONS
Rigid proctosigmoidoscopy localization of rectal tumors can significantly change treatment options and should be performed on all patients with colonoscopic localization of a cancer thought to be in the rectosigmoid or rectum.
Topics: Diagnosis, Differential; Equipment Design; Humans; Proctoscopes; Proctoscopy; Rectal Neoplasms; Reproducibility of Results; Retrospective Studies; Sigmoid Neoplasms; Sigmoidoscopes; Sigmoidoscopy
PubMed: 19095107
DOI: 10.1016/j.amjsurg.2008.08.005 -
Acta Chirurgica Belgica 2008Benign rectal tumours represent a frequently occurring condition that often requires surgical treatment. In the literature, Transanal Endoscopic Microsurgery (TEM) has...
Benign rectal tumours represent a frequently occurring condition that often requires surgical treatment. In the literature, Transanal Endoscopic Microsurgery (TEM) has claimed a position as the gold standard for this kind of transanal surgery. In this study, we evaluate the results in a series of 34 patients who underwent a transanal resection after an extensive pre-operative work-up, using the Fansler proctoscope. Although the level of evidence in retrospective studies may have its limitations, our results seem to meet those of TEM in the literature. Also, the Fansler proctoscope provides us with a much more economical and easier to learn method. We conclude that the Fansler proctoscope approach can be a valuable alternative to TEM in the treatment of benign rectal tumours.
Topics: Adenocarcinoma; Adenoma, Villous; Adult; Aged; Aged, 80 and over; Ambulatory Surgical Procedures; Equipment Design; Female; Hospitalization; Humans; Male; Middle Aged; Proctoscopes; Rectal Neoplasms; Rectum
PubMed: 19051462
DOI: 10.1080/00015458.2008.11680281 -
Gastrointestinal Endoscopy Nov 2008The excitement surrounding natural orifice transluminal endoscopic surgery (NOTES) remains tempered by concerns over safe access and closure of transvisceral...
BACKGROUND
The excitement surrounding natural orifice transluminal endoscopic surgery (NOTES) remains tempered by concerns over safe access and closure of transvisceral enterotomies. Research in NOTES has commonly been described as using an oral transgastric access point. Transanal endoscopic microsurgery (TEM) is a minimally invasive technique for a full-thickness resection of rectal tumors and with suture closure of the resultant defect with highly specialized instruments. This technique has been used clinically in human beings for more than 2 decades. Entry into the peritoneal cavity during a resection of rectosigmoid lesions has been described, and safe closure can be obtained.
OBJECTIVE
To assess the feasibility of transrectal NOTES procedures by using TEM instrumentation.
DESIGN
Three porcine and 3 human cadaver models were studied by using standard TEM instrumentation and flexible endoscopes. NOTES peritoneal access, a peritoneoscopy, a liver biopsy, and colorectal resections were performed.
RESULTS
True NOTES procedures facilitated with TEM instrumentation were successfully completed.
LIMITATIONS
This was a preclinical study, and several challenges to bridging to human clinical use exist: TEM instruments are currently designed for intraluminal tasks low in the pelvis, with 5-mm to 10-mm port sizes; the cost of the TEM instruments and insufflation system; and the learning curve to perform TEM closure.
CONCLUSIONS
Our preclinical study demonstrated the feasibility of several transrectal NOTES procedures, colorectal resection, and anastomosis when using TEM instrumentation. We, therefore, suggest TEM as a portal for NOTES.
Topics: Anastomosis, Surgical; Animals; Biopsy; Cadaver; Colectomy; Colon; Feasibility Studies; Humans; Laparoscopy; Liver; Microsurgery; Minimally Invasive Surgical Procedures; Pneumoperitoneum, Artificial; Proctoscopes; Proctoscopy; Rectum; Surgical Stapling; Sus scrofa
PubMed: 18984102
DOI: 10.1016/j.gie.2008.03.1115 -
Acta Cirurgica Brasileira 2008The transanal procedure for rectal cancer surgery is one of the many techniques currently available. Different techniques for local excision of rectal tumors include:... (Comparative Study)
Comparative Study
PURPOSE
The transanal procedure for rectal cancer surgery is one of the many techniques currently available. Different techniques for local excision of rectal tumors include: conventional transanal technique, posterior access surgery, therapeutic colonoscopy, transanal endoscopic surgery.
METHODS
The aim of the present study is to describe a new method of transanal endoscopic resection, transanal endoscopic operation (TEO), and performed with the aid of a surgical proctoscope especially designed for this purpose and report the results obtained in 32 patients submitted to the TEO and to compare these results with those obtained with other techniques currently available. The average proportions of recurrence, post-operation complications and posterior resections were analyzed by means of a metanalysis. Data on the distance and size of rectal lesions, the operative timing and hospitalization time were distributed in graphs according to authors and techniques.
RESULTS
The results were favorable and equivalent to those described in the literature.
CONCLUSIONS
The surgical proctoscope specially designed for this study is efficient and has a low cost; the TEO is easily performed with the aid of this equipment; the final results were favorable and similar to those obtained with other available techniques for endoscopic transanal intestinal resection, which are of high cost and less availability.
Topics: Adenocarcinoma; Adenoma; Anal Canal; Equipment Design; Follow-Up Studies; Humans; Length of Stay; Neoplasm Recurrence, Local; Proctoscopes; Proctoscopy; Rectal Neoplasms; Time Factors; Treatment Outcome
PubMed: 18516455
DOI: 10.1590/s0102-86502008000700016 -
Techniques in Coloproctology Sep 2008Transanal access is one of many currently used procedures for rectal cancer treatment. The techniques used for local excision include conventional transanal excision,...
Transanal access is one of many currently used procedures for rectal cancer treatment. The techniques used for local excision include conventional transanal excision, posterior access, therapeutic colonoscopy and transanal endoscopic approaches. The aim of the present study was to present a new surgical proctoscope for the endoscopic transanal excision of rectal lesions. A cylindrical proctoscope with a diameter of 4 cm was devised and built. The end inserted into the anus has a bevelled aspect and rounded borders, allowing correct exposure of the anal lesion. The rectoscope is fixed to the anal border with surgical thread through perforations in the external end. A base screw holds a fibre-light which illuminates the operative field. Part of the equipment is a guide which is positioned inside the rectoscope on insertion into the anus. In operations utilizing this proctoscope, 17 adenomas, 25 adenocarcinomas, 1 carcinoid and 1 endometrioma were excised. The diameter of the lesions varied from 1 to 6 cm. The range of procedures that are possible with this new proctoscope are similar to those achieved with conventional techniques which, however, require more expensive equipment. Hence, the present study demonstrates that this newly devised low-cost proctoscope is an efficient tool for the transanal endoscopic excision of rectal lesions.
Topics: Adenocarcinoma; Adenoma; Endoscopy, Gastrointestinal; Equipment Design; Humans; Proctoscopes; Rectal Neoplasms
PubMed: 18679568
DOI: 10.1007/s10151-008-0429-3 -
Tropical Doctor Jul 2008A cheaper version of a self-illuminated proctoscope which suitable for use in developing countries designed for diagnosis and intervention in anorectal diseases is...
A cheaper version of a self-illuminated proctoscope which suitable for use in developing countries designed for diagnosis and intervention in anorectal diseases is described.
Topics: Anus Diseases; Humans; Proctoscopes; Proctoscopy; Rectal Diseases
PubMed: 18628540
DOI: 10.1258/td.2007.070133 -
Techniques in Coloproctology Jun 2008An optimal stapled haemorrhoidopexy requires the purse-string suture to be placed circumferentially at a constant distance from the dentate line and to pass through an...
An optimal stapled haemorrhoidopexy requires the purse-string suture to be placed circumferentially at a constant distance from the dentate line and to pass through an appropriate thickness of rectal mucosa. An unsuitable purse-string suture may increase the risk of postoperative complications. We developed a new anoscope (the videoanoscope) to prevent the difficulties during application of the purse-string suture, and we used the videoanoscope in 18 stapled haemorrhoidopexy procedures. The videoanoscope is made up of three pieces. The front part is in the form of an open half-cylinder. The second piece is a sliding lid that covers the front piece. The rear part of the anoscope includes a hollow handle in which a scope can be inserted, and the whole procedure can be transmitted to a monitor via this scope. The opening on the anoscope can be adjusted by sliding the lid. A purse-string suture is placed on the rectal mucosa protruding through this adjustable opening. The anoscope is rotated to apply the subsequent suture bites and when the starting point is reached again the purse-string is completed. Then the stapled haemorrhoidopexy procedure is continued in the usual fashion. Videoanoscope-assisted stapled haemorrhoidopexy was easily performed in 18 patients (12 men, 6 women; mean age 48.9 years). The mean operative time was 32.8 minutes. The excised rectal mucosal rings were complete in all of the patients. Optimal purse-string depth was reflected in the presence of only mucosa and submucosa in all specimens, without incorporation of muscle cells. Postoperative complications were urinary retention in one patient and bleeding in five patients, one of whom requiring sutures for haemostasis. Further studies are required to assess the potential advantages of this technique.
Topics: Adult; Aged; Aged, 80 and over; Equipment Design; Female; Hemorrhoids; Humans; Male; Middle Aged; Proctoscopes; Surgical Stapling; Treatment Outcome; Video-Assisted Surgery
PubMed: 18545879
DOI: 10.1007/s10151-008-0410-1