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International Journal of Colorectal Disease

, Volume 32, Issue 7, pp 1041–1045 | Cite as

What is the best tool for transanal endoscopic microsurgery (TEM)? A case-matched study in 74 patients comparing a standard platform and a disposable material

  • Diane Mege
  • Valérie Bridoux
  • Léon Maggiori
  • Jean-Jacques Tuech
  • Yves PanisEmail author
Short Communication

Abstract

Purpose

Transanal endoscopic microsurgery (TEM) is the gold standard for local excision of rectal lesions, but no study exists concerning the best material. The objective was to compare TEM using a disposable material vs a standard platform through a case-matched study.

Methods

Patients who underwent TEM for rectal neoplasms were identified from prospective databases in two tertiary referral centers and matched according to four criteria (sex, tumor location, size, distance from the anal verge): TEM using a disposable material (GelPoint Applied®; group A) and TEM using a standard TEO® platform (Karl Storz, Tuttlingen, Germany; group B).

Results

A total of 74 patients were included and divided into group A (n = 33) and group B (n = 41). Full-thickness resection was less frequent in group A (85%) than B (100%; p = 0.01). Adenocarcinoma was less frequent in group A than B: 27 vs 42% (p = 0.03). No difference was noted regarding median operative time (53 vs 53 min; p = 0.6) and a peritoneal perforation rate (6 vs 20%; p = 0.17). Median length of stay was shorter in group A than B (4 vs 5 days; p < 0.008). No significant difference was noted for major morbidity (12 vs 10%; p = 0.66), R1 resection (21 vs 10%; p = 0.2), and recurrence rates (8 vs 7%; p = 0.62). No difference was noted for rectal stenosis (3 vs 12%; p = 0.22) and transit disorder rates (12 vs 17%; p = 0.74).

Conclusions

Our study suggested that TEM can be performed using either a TEO® platform or a disposable material, with similar surgical results. The TEO® platform seems to be superior to obtain full-thickness and R0 resection.

Keywords

Transanal endoscopic microsurgery Local excision Rectal lesion Peritoneal perforation 

Notes

Compliance with ethical standards

Sources of funding

None.

References

  1. 1.
    Christoforidis D, Cho H-M, Dixon MR et al (2009) Transanal endoscopic microsurgery versus conventional transanal excision for patients with early rectal cancer. Ann Surg 249(5):776–782CrossRefPubMedGoogle Scholar
  2. 2.
    Peng J, Chen W, Sheng W et al (2011) Oncological outcome of T1 rectal cancer undergoing standard resection and local excision. Color Dis 13(2):e14–e19CrossRefGoogle Scholar
  3. 3.
    Buess G, Kipfmüller K, Hack D et al (1988) Technique of transanal endoscopic microsurgery. Surg Endosc 2(2):71–75CrossRefPubMedGoogle Scholar
  4. 4.
    Atallah S, Albert M, Larach S (2010) Transanal minimally invasive surgery: a giant leap forward. Surg Endosc 24(9):2200–2205CrossRefPubMedGoogle Scholar
  5. 5.
    Lim S-B, Seo S-I, Lee JL et al (2012) Feasibility of transanal minimally invasive surgery for mid-rectal lesions. Surg Endosc 26(11):3127–3132CrossRefPubMedGoogle Scholar
  6. 6.
    Lorenz C, Nimmesgern T, Back M et al (2010) Transanal single port microsurgery (TSPM) as a modified technique of transanal endoscopic microsurgery (TEM). Surg Innov 17(2):160–163CrossRefPubMedGoogle Scholar
  7. 7.
    Ragupathi M, Haas EM (2011) Transanal endoscopic video-assisted excision: application of single-port access. JSLS 15(1):53–58CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Hayashi S, Takayama T, Yamagata M et al (2013) Single-incision laparoscopic surgery used to perform transanal endoscopic microsurgery (SILSTEM) for T1 rectal cancer under spinal anesthesia: report of a case. Surg Today 43(3):325–328CrossRefPubMedGoogle Scholar
  9. 9.
    Rimonda R, Arezzo A, Arolfo S et al (2013) Transanal minimally invasive surgery (TAMIS) with SILS™ port versus transanal endoscopic microsurgery (TEM): a comparative experimental study. Surg Endosc 27(10):3762–3768CrossRefPubMedGoogle Scholar
  10. 10.
    Saget A, Maggiori L, Petrucciani N et al (2015) Is there a limit to transanal endoscopic surgery? A comparative study between standard and technically challenging indications among 168 consecutive patients. Color Dis 17(7):O155–O160CrossRefGoogle Scholar
  11. 11.
    Hompes R, Ris F, Cunningham C et al (2012) Transanal glove port is a safe and cost-effective alternative for transanal endoscopic microsurgery. Br J Surg 99(10):1429–1435CrossRefPubMedGoogle Scholar
  12. 12.
    Barendse RM, Doornebosch PG, Bemelman WA et al (2012) Transanal employment of single access ports is feasible for rectal surgery. Ann Surg 256(6):1030–1033CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  • Diane Mege
    • 1
    • 2
  • Valérie Bridoux
    • 1
  • Léon Maggiori
    • 2
  • Jean-Jacques Tuech
    • 1
  • Yves Panis
    • 2
    Email author
  1. 1.Department of Digestive SurgeryCharles Nicolle HospitalRouenFrance
  2. 2.Department of Colorectal Surgery, Beaujon Hospital, Assistance Publique-Hôpitaux de ParisUniversité Paris VIIClichyFrance

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