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:经肛门切除良性和恶性直肠肿瘤是一种广为接受的手术技术。如Buess等人在1984年最初描述的,使用立体显微外科技术已显示可通过允许距肛门边缘长达24 cm的精确,全层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)未能获得广泛的普及,其原因有两个:专有的器械套件昂贵且复杂(68,000美元,包含30个组件),并且该过程在技术上难以掌握。我们通过修改TEM仪器(结合标准腹腔镜和摄像机以及标准腹腔镜仪器)展示我们的结果。

方法:到目前为止,已经培训了四名外科医生。介绍了培训课程的详细信息。描述了视频内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。

结果:1994年8月至1996年6月,四名外科医生进行了27例VTEM病例。平均年龄为69岁。年,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),在外科医生的前5例中以及距肛门边缘16厘米以上的病变中,手术时间更长。手术中很少有手术问题(4%),术后并发症(尿失禁2,晚期出血1,腺瘤复发1)占15%。

结论:可以教VTEM使用类似于高级腹腔镜课程的格式成功地向胃肠道和结直肠外科医生使用。使用已经可用的腹腔镜和仪器可降低安装的初始成本。结果良好,并发症和复发率低,住院时间很短。患者可以从有效,微创的替代开放手术中受益。

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