-
Annals of Saudi Medicine 2023Although transanal minimally invasive surgery (TAMIS) for rectal neoplasia has gained wide acceptance, the mid-term and long-term outcomes are not widely reported in the...
BACKGROUND
Although transanal minimally invasive surgery (TAMIS) for rectal neoplasia has gained wide acceptance, the mid-term and long-term outcomes are not widely reported in the literature.
OBJECTIVE
Describe the mid-term outcomes of patients who underwent TAMIS for benign and malignant rectal lesions in a single center.
DESIGN
Retrospective cohort study.
SETTINGS
Tertiary referral center.
PATIENTS AND METHODS
Demographic, clinical, and oncological outcomes of patients who underwent TAMIS between January 2015 and December 2022 were prospectively collected. The indication for TAMIS was based on the National Comprehensive Cancer Network guidelines. The follow up for the cancer patients included clinical examination, tumor markers every 6 months and MRI rectum at the end of one year. In addition, colonoscopy and CT scan at years one and three and a final CT scan and colonoscopy at year five.
MAIN OUTCOME MEASURES
Mid-term oncological and clinical outcome.
RESULTS
Thirty elective TAMIS procedures included adenocarcinoma for 33.3% (n=10) of the patients, 20% (n=6) neuroendocrine tumor and the 40% (n=12) were adenomatous lesions. Negative resection margins were achieved in all malignant lesions. Perioperative complications occurred in 2 patients (6.6%), one patient had breaching into the peritoneal cavity, and postoperative hypotension occurred in another patient. The median follow-up time was 23 months (range: 5-72 months). Two patients with adenoma and positive margins developed recurrent adenoma (6.6%) and one patient with initial polypectomy biopsy of adenocarcinoma, had TAMIS with histopathology of adenoma and distant metastasis had developed.
CONCLUSIONS
TAMIS for local excision of rectal neoplasia is a valid option with favorable mid-term outcomes provided there is adherence to careful selection criteria.
LIMITATIONS
Retrospective nature and small number of the patients.
Topics: Humans; Rectum; Retrospective Studies; Treatment Outcome; Minimally Invasive Surgical Procedures; Rectal Neoplasms; Transanal Endoscopic Surgery; Adenoma; Adenocarcinoma; Anal Canal
PubMed: 38071443
DOI: 10.5144/0256-4947.2023.348 -
Colorectal Disease : the Official... Jan 2020A new artificial anal sphincter placed into the intersphincteric space, SphinKeeper™, has recently been proposed to improve outcomes in the treatment of faecal...
AIM
A new artificial anal sphincter placed into the intersphincteric space, SphinKeeper™, has recently been proposed to improve outcomes in the treatment of faecal incontinence (FI). We report our preliminary results with short-term follow-up, comparing preoperative and postoperative data after implant of SphinKeeper™ in patients suffering from FI.
METHODS
All patients older than 18 years were included with FI of at least 6 months, incontinence episodes occurring more than once a week and resistance to other conservative treatments. Anorectal manometry, endoanal ultrasound, Cleveland Clinic FI Score, FI Quality of Life score and total number of episodes of FI per week were recorded preoperatively and at the end of the 6-month follow-up period.
RESULTS
Thirteen consecutive patients were treated with SphinKeeper™. No intra-operative nor postoperative complications were reported. Two cases of prosthesis extrusion occurred, and in one case an anterior dislocation was detected. Maximum resting pressure, total number of episodes of FI per week and Cleveland Clinic FI Score were improved after 6 months (P < 0.05).
CONCLUSIONS
SphinKeeper™ could be a minimally invasive procedure for FI with good postoperative outcomes. If these results are confirmed by studies with more patients and longer follow-up, it could be a first-line approach in FI.
Topics: Adult; Anal Canal; Endosonography; Fecal Incontinence; Female; Humans; Male; Manometry; Middle Aged; Postoperative Period; Preoperative Period; Prosthesis Implantation; Quality of Life; Severity of Illness Index; Transanal Endoscopic Surgery; Treatment Outcome
PubMed: 31373152
DOI: 10.1111/codi.14801 -
World Journal of Gastroenterology Nov 2015Low anterior resection can be a challenging operation, especially in obese male patients and in particular after radiotherapy. Transanal total mesorectal excision... (Review)
Review
Low anterior resection can be a challenging operation, especially in obese male patients and in particular after radiotherapy. Transanal total mesorectal excision (TaTME) might offer technical advantages over laparoscopic or open approaches particularly for tumors in the distal third of the rectum. The aim of this article is to review the current experience with TaTME. The limits and future developments are also explored. Although the experience with TaTME is still limited, it might be a promising alternative to laparoscopic TME, especially for difficult cases where laparoscopy is too demanding. The preliminary data on complications and short-term oncological outcomes are good, but also emphasize the importance of careful patient selection. Finally, there is a need for large-scale trials focusing on long-term outcomes and oncological safety before widespread adoption can be recommended.
Topics: Adenocarcinoma; Diffusion of Innovation; Humans; Laparoscopy; Patient Selection; Postoperative Complications; Rectal Neoplasms; Rectum; Risk Factors; Robotic Surgical Procedures; Transanal Endoscopic Surgery; Treatment Outcome
PubMed: 26556997
DOI: 10.3748/wjg.v21.i41.11700 -
Genitourinary Medicine Dec 1985Chlamydia trachomatis was isolated from 21 (7%) of 309 specimens obtained in October 1982 from the rectum of homosexual men undergoing proctoscopy. During the same...
Chlamydia trachomatis was isolated from 21 (7%) of 309 specimens obtained in October 1982 from the rectum of homosexual men undergoing proctoscopy. During the same period Neisseria gonorrhoeae was isolated from 12 (3%) of 454 specimens obtained similarly. The clinical features of patients infected with each of these micro-organisms were compared with those of an uninfected group of homosexual men. No characteristic diagnostic features were noted in the infected men.
Topics: Adult; Chlamydia Infections; Chlamydia trachomatis; Homosexuality; Humans; Male; Neisseria gonorrhoeae; Proctitis; Rectum
PubMed: 3936777
DOI: 10.1136/sti.61.6.376 -
Irish Journal of Medical Science Apr 2022Transanal minimally invasive surgery (TAMIS) has gained worldwide acceptance as a means of local excision of early rectal cancers and benign rectal lesions. However, it... (Review)
Review
Transanal minimally invasive surgery (TAMIS) has gained worldwide acceptance as a means of local excision of early rectal cancers and benign rectal lesions. However, it is technically challenging due to the limitations of rigid laparoscopic instruments in the narrow rectal lumen. Robotic platforms offer improved ergonomics that are valuable in operative fields with limited space. Robotic TAMIS represents an exciting new development that may be more versatile than traditional TAMIS. In this review, we describe the first case of robotic TAMIS performed in our country and a review of current literature on the technique.
Topics: Humans; Ireland; Rectal Neoplasms; Rectum; Robotic Surgical Procedures; Transanal Endoscopic Surgery
PubMed: 33977392
DOI: 10.1007/s11845-021-02645-9 -
Actas Dermo-sifiliograficas Dec 2011The incidence of anal squamous cell carcinoma has increased alarmingly, particularly in high-risk groups such as men who have sex with men and immunosuppressed patients.... (Review)
Review
The incidence of anal squamous cell carcinoma has increased alarmingly, particularly in high-risk groups such as men who have sex with men and immunosuppressed patients. Infection with an oncogenic strain of the human papillomavirus in the anal canal or perianal skin leads to anal intraepithelial neoplasias (AIN), progressive dysplastic intraepithelial lesions that are the precursors of anal squamous cell carcinoma. AIN can be diagnosed through cytological screening and biopsy guided by high-resolution anoscopy and can be treated using a range of procedures in an effort to prevent progression to invasive anal carcinoma. Given the recent advances in the understanding of this disease, and the increasing calls from experts for the establishment of screening programs to identify AIN, we review current knowledge on the condition, its diagnosis, and treatment from the point of view of dermatology.
Topics: Algorithms; Alphapapillomavirus; Antiretroviral Therapy, Highly Active; Anus Neoplasms; Biopsy; Carcinoma in Situ; Carcinoma, Squamous Cell; Comorbidity; Disease Susceptibility; Early Diagnosis; Forecasting; HIV Infections; Humans; Immunocompromised Host; Incidence; Mass Screening; Papillomavirus Infections; Precancerous Conditions; Proctoscopy; Risk; Sexual Behavior
PubMed: 21764027
DOI: 10.1016/j.ad.2011.01.005 -
European Archives of... Aug 2015The purpose of the study was to perform a systematic review and meta-analysis of the literature to compare the efficacy (and other postoperative outcomes) of... (Review)
Review
The purpose of the study was to perform a systematic review and meta-analysis of the literature to compare the efficacy (and other postoperative outcomes) of nonabsorbable versus absorbable nasal packing after functional endoscopic sinus surgery (FESS) for the treatment of chronic rhinosinusitis. Studies were considered for inclusion if they were published in English language, were randomized clinical trials, and reported on outcomes following postoperative synechia. The primary outcome for meta-analysis was the incidence of postoperative synechia; pooled odds ratios (ORs) and 95 % confidence intervals (CIs) were calculated using fixed-effects models. Five studies, involving 241 nasal cavities in each treatment group, were included in the systematic review. The prevalence of synechia ranged from 4.6 to 8.0 % in the absorbable groups and from 8.0 to 35.7 % in the nonabsorbable groups. Postoperative bleeding was lower in the absorbable groups, whereas there was no clear finding regarding postoperative pain. Postoperative edema was generally similar between groups. There were no consistent findings regarding bleeding and pain on packing removal. Two studies using the same type of packing material were included in the meta-analysis. The combined OR (0.33, 95 % CI 0.04-2.78) for postoperative synechia did not significantly favor (P = 0.308) absorbable packing over nonabsorbable packing. Although there is some evidence in the available literature that absorbable nasal packing may provide superior outcomes to nonabsorbable packing after FESS, the lack of homogeneity between studies makes definitive conclusions impossible. Further randomized clinical trials are needed to compare the efficacy of different types of absorbable nasal packing for preventing synechia after FESS.
Topics: Chronic Disease; Hemostasis, Surgical; Humans; Postoperative Hemorrhage; Rhinitis; Sinusitis; Transanal Endoscopic Surgery; Treatment Outcome
PubMed: 24927828
DOI: 10.1007/s00405-014-3107-2 -
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 -
Danish Medical Journal Jul 2019The advantages of transanal total mesorectal excision (taTME) would be a reduction of the hernia rate and surgical trauma. The present study reports data for patients... (Comparative Study)
Comparative Study
INTRODUCTION
The advantages of transanal total mesorectal excision (taTME) would be a reduction of the hernia rate and surgical trauma. The present study reports data for patients undergoing taTME and compares the post-operative immune response in taTME with those of conven-tional laparoscopic surgery (CLS) and single-port laparo-scopic surgery (SPLS).
METHODS
A comparative cohort study in patients with rectal cancer undergoing taTME. C-reactive protein (CRP) and white blood cell count (WBC) were measured pre-operatively and on post-operative days one, two, three and four.
RESULTS
A total of 40 patients were included in taTME, 20 patients in CLS and 20 in SPLS. Patients' demographics (except for clinical staging), R0 resection and post-operative complication rates were comparable. The length of abdom-inal incisio-n was significantly lower by taTME than by both SPLS and CLS (p < 0.001). Distant resection margin was shorter in the taTME group (p < 0.01), and the quality of specimen differed between groups (p < 0.01). CRP and WBC increased significantly in each group (p < 0.05), but there was no difference between the groups.
CONCLUSIONS
There is no difference in the inflammatory response in patients with rectal cancer undergoing taTME surgery compared with CLS and SPLS. We therefore conclude that the length/presence of abdominal incision does not further reduce the post-operative inflammatory stress response in minimally invasive procedures. The surgical trauma extends beyond the abdominal incision and depends on the intra-abdominal handling of the tissue.
FUNDING
none.
TRIAL REGISTRATION
ID NCT00157972, ethical approval ID H-1-2011-007, H-15000540.
Topics: Aged; Aged, 80 and over; C-Reactive Protein; Cohort Studies; Female; Humans; Inflammation; Laparoscopy; Leukocyte Count; Male; Middle Aged; Neoplasm Recurrence, Local; Operative Time; Postoperative Complications; Rectal Neoplasms; Transanal Endoscopic Surgery
PubMed: 31256779
DOI: No ID Found -
Journal of Investigative Surgery : the... Dec 2023To compare the effectiveness, safety and cost-effectiveness of endoscopic submucosal dissection (ESD) with transanal endoscopic microsurgery (TEM) in early rectal... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
To compare the effectiveness, safety and cost-effectiveness of endoscopic submucosal dissection (ESD) with transanal endoscopic microsurgery (TEM) in early rectal neuroendocrine tumor (RNET) patients. This article will provide reliable evidence for surgeons in regards to clinical decision-making.
METHODS
Systematic literature retrieval was performed in Pubmed, Embase and Cochrane database from 2013/4/30 to 2023/4/30. Methodology validation was performed by using the Newcastle-Ottawa Scale (NOS). Data-analysis was conducted by using the Review manager version 5.3 software.
RESULTS
A total of three retrospective studies were included in our meta-analysis. All eligible studies were considered to be high quality. By comparing baseline characteristics between TEM and ESD, patients in the TEM group seemed to be characterized by a larger tumor size and lower tumor level, even though no statistical significance was found. Clear statistical significance favoring TEM was identified in terms of R0 resection rate, procedure time and hospital stay. No statistical significance was found in terms of recurrence rate, adverse events rate and additional treatment rate.
CONCLUSIONS
Compared with ESD, TEM was a more effective treatment modality for early RNET patients; it was associated with a relatively higher R0 resection rate and a similar degree of safety. However, the relatively higher cost and complicated manipulation restricted the promotion of TEM. Surgeons should opt for TEM as a primary treatment in patients with a larger tumor size and deeper degree of tumorous infiltration if the financial condition and hospital facility permit.
Topics: Humans; Transanal Endoscopic Microsurgery; Endoscopic Mucosal Resection; Neuroendocrine Tumors; Retrospective Studies; Rectal Neoplasms
PubMed: 37970828
DOI: 10.1080/08941939.2023.2278191