Transanal endoscopic microsurgery for rectal carcinoma at the site of a previous ureteroenterostomy.
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Anal Canal↗
Biomedical subjects
E J R de Graaf
Publications and source records attributed to E J R de Graaf.
Ultracision Harmonic Scalpel and multifunctional tem400 instrument complement in transanal endoscopic microsurgery: a prospective study.
BACKGROUND: For transanal endoscopic microsurgery, the ultracision Harmonic Scalpel (UC) and the multifunctional TEM400 instrument (T400) seem advantageous. This study investigated their clinical use. METHODS: Prospective analysis of tumor, patient, and operation characteristics was performed for 196 tumor resections per instrument intended for application. RESULTS: The T400 instrument was applied in 162 operations, and the UC in 34 operations. Tumor and patient characteristics were similar except for tumor area (respectively, 7.5 and 17 cm(2); p = 0.003). Operative time was proportionate to the tumor area (p < 0.001) and inversely proportionate to its distance from the dentate line to the lower margin of the tumor of the UC (p = 0.002). Application reduced operative time by 26% (p = 0.02, corrected for area). Whereas, T400 was always singly sufficient for excision, the UC required T400 application in 50% of operations, especially for larger tumors (p = 0.026), with the result that more rectal wall circumference was captured (p = 0.043). Both groups had similar safety parameters. CONCLUSIONS: The UC substantially reduced operative time compared with the T400, but frequently required the T400 for procedure completion. The T400 is always singly sufficient.
Adult↗
Use of head-mounted display in transanal endoscopic microsurgery.
BACKGROUND: Head-mounted display (HMD) decreases the forced adjustments of position and eyes in endoscopic surgery. During transanal endoscopic microsurgery (TEM), these adjustments might even be greater because of the direct viewing technique. We investigated the feasibility of HMD in TEM. METHODS: Head-mounted display is a helmet with two built-in displays. The stereoscopic endoscope (with two separate lens systems) provides separate images at each display. During TEM, standard stereoscopic optic and HMD were alternated. RESULTS: Use of HMD was possible after construction of a special device. The helmet was comfortable to wear, and the peripheral view was adequate. The operator's position was upright and relaxed. The range and depth of vision seemed comparable with those of the standard stereoscopic optic. The quality of the displays in the helmet is limited. CONCLUSIONS: Head-mounted display is feasible in TEM. It enables a more relaxed position and view on the operative field. The quality of the display in the helmet requires improvement.
Adenoma, Villous↗
Transanal endoscopic microsurgery.
BACKGROUND: Transanal endoscopic microsurgery (TEM) is a newly developed, minimally invasive technique for the local resection of rectal tumours. Its place needs to be defined. METHODS: Literature review. RESULTS: Local excision of rectal tumours is associated with low mortality and morbidity. It is indicated in adenomas for curation and in rectal cancer for palliation. Transanal resection is used most frequently, but its use is limited. Other local techniques have no added value and are used sparingly. TEM is a newly developed, minimally invasive technique. Its technical characteristics allow an excellent view also in larger and more proximal tumours. Compared to other local techniques, mortality and morbidity are minimal and a laparotomy is more often preventable. Proper histological examination is possible and free margins are almost always observed. In adenomas it results in hardly any recurrences and in rectal cancer it can be adequately used for palliation. The results following local resection for rectal cancer with curative intent are promising, but they are only described anecdotally. CONCLUSIONS: TEM is an elegant technique with excellent results. It imposes itself as a method of choice for the local resection of rectal adenomas and of rectal cancer for palliation. If curation is intended in rectal carcinomas, TEM should be exercised with caution. Proper judgement over existing local techniques and TEM is being impeded by a lack of scientific argumentation.
Adenoma↗
Transanal endoscopic microsurgery for rectal cancer.
If curation is intended for rectal cancer, total mesorectal excision with autonomic nerve preservation (TME) is the gold standard. Transanal resection is tempting because of low mortality and morbidity rates. However, inferior tumour control, provoked by the limitations of the technique, resulted in its cautious application and use mainly for palliation. Transanal endoscopic microsurgery (TEM) is a minimal invasive technique for the local resection of rectal tumours. It is a one-port system, introduced transanally. An optical system with a 3D-view, 6-fold magnification and resolution as the human eye, together with the creation of a stabile pneumorectum, and specially designed instruments allow full-thickness excision under excellent view and a proper histological examination. The technique can also be applied for larger and more proximal tumours. Mortality, morbidity as well as incomplete excision rates are minimal. Local recurrence and survival rates seem comparable to TME in early rectal cancer. TEM is the method of choice when local resection of rectal cancer is indicated. Results justify a re-evaluation of the indications for the local excision of rectal cancer with a curative intent.
Adult↗
Local formalin instillation: an effective treatment for uncontrolled radiation-induced hemorrhagic proctitis.
AIM: The aim of this study was to evaluate the efficacy of local instillation of 4% formalin in the management of uncontrolled radiation-induced and ischemic hemorrhagic proctitis. PATIENTS AND METHODS: Eight patients were reviewed. Operation characteristics, morbidity and long-term results were analyzed. RESULTS: All patients were followed for a median of 18 months. In 5 patients the bleeding stopped after a single treatment and in 3 after a second one. During follow-up no recurrent rectal bleeding occurred, no further medical treatment was needed and in all patients the complaints had disappeared. CONCLUSION: Local instillation of 4% formalin is an effective treatment for uncontrolled radiation-induced and ischemic hemorrhagic proctitis.
Administration, Rectal↗