BACKGROUND:Transanal resection of benign and selected malignant rectal tumors is a well accepted surgical technique. The use of a stereoscopic microsurgical technique, as originally described by Buess et al in 1984, has been shown to improve the results of standard transanal resection by allowing precise, full thickness resections up to 24 cm from the anal verge. Transanal endoscopic microsurgery (TEM) has failed to gain widespread popularity for two reasons: The proprietary instrument set is expensive and complex ($68,000 and 30 components), and the procedure is difficult to master technically. We present our results with a modification of the TEM instrument that incorporates a standard laparoscope and video camera as well as standard laparoscopic instruments.

METHODS:Four surgeons have been trained to date. Details of the training curriculum are presented. The technique of videoendoscopic transanal tumor resection (VTEM) is described. A prospective data base was maintained of all VTEM cases. This was reviewed for this study to determine indications, operative times, complications and outcomes.

RESULTS:Four surgeons performed 27 VTEM cases between August 1994 and June 1996. The average age was 69 years and the majority (16) of patients were ASA III. Pre-op diagnosis was benign polyp in 25 patients and adenocarcinoma in 2. Average operating time was 127 minutes (49 to 280 minutes), and was longer during a surgeon's first 5 cases and for lesions more than 16 cm from the anal verge. Operative problems were rare (4%) and post-op complications (incontinence 2, late bleeding 1, adenoma recurrence 1) were seen in 15%.

CONCLUSIONS:VTEM can be taught successfully to GI and colorectal surgeons using a format similar to that used for advanced laparoscopic courses. The use of already available laparoscopes and instruments decreases the initial costs of the set-up. Results are good, with low rates of complications and recurrence and a very short hospital stay. The patient benefits from an effective, minimally invasive alternative to open surgery.

译文

背景 : 经肛门切除良性和选定的恶性直肠肿瘤是一种公认的手术技术。如Buess等人1984年最初描述的那样,使用立体显微外科技术已被证明通过允许从肛门边缘最多24厘米个精确的全厚度切除来改善标准经肛门切除的结果。经肛门内窥镜显微外科手术 (TEM) 未能获得广泛的欢迎,原因有两个: 专有仪器套件昂贵且复杂 (68,000美元和30个组件),并且该程序在技术上难以掌握。我们通过对TEM仪器的改进来展示我们的结果,该TEM仪器结合了标准的腹腔镜和摄像机以及标准的腹腔镜仪器。
方法 : 迄今为止,已经对四名外科医生进行了培训。介绍了培训课程的详细信息。描述了视频内窥镜经肛门肿瘤切除术 (VTEM) 的技术。保留了所有VTEM病例的前瞻性数据库。本研究对此进行了审查,以确定适应症,手术时间,并发症和结果。
结果 : 四名外科医生在1994年8月和1996年6月之间进行了27例VTEM病例。平均年龄为69岁,大多数 (16) 患者为ASA III。术前诊断为良性息肉25例,腺癌2例。平均手术时间为127分钟 (49至280分钟),并且在外科医生的前5例病例中较长,并且对于肛门边缘的病变超过16厘米。手术问题很少见 (4%),15% 术后并发症 (失禁2,晚期出血1,腺瘤复发1)。
结论 :VTEM可以使用类似于高级腹腔镜课程的格式成功地教给GI和结肠直肠外科医生。使用已经可用的腹腔镜和仪器可以降低设置的初始成本。结果良好,并发症和复发率低,住院时间短。患者受益于开放手术的有效,微创替代方法。

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