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Combining ultrasonic dissection and the Storz operation rectoscope.
M M Lirici1, M Di Paola, C Ponzano
1Department of Surgery, Ospedale S. Giovanni, Via Amba Aradam 8, 00184 Rome, Italy. marcomlirici@tiscalinet.it
Surgical Endoscopy
|May 10, 2003
Summary
A modified transanal endoscopic microsurgery (TEM) using a Storz rectoscope and ultrasonic dissection offers a cost-effective and efficient approach for rectal tumor resection. This technique provides optimal coagulation and a clear surgical field, with no observed recurrence in initial studies.
Area of Science:
- Colorectal Surgery
- Minimally Invasive Surgery
- Surgical Technology
Background:
- Transanal endoscopic microsurgery (TEM) enables precise rectal tumor resection but involves complex, costly equipment and technical challenges.
- Bleeding and oozing can complicate standard TEM procedures, requiring advanced surgical skills.
Purpose of the Study:
- To evaluate a modified TEM technique utilizing a new Storz operation rectoscope and ultrasonic dissection.
- To address the limitations of conventional TEM, including equipment cost, skill requirement, and intraoperative bleeding.
Main Methods:
- The modified TEM employed a 5-mm telescope, single-monitor display, standard laparoscopic instruments, and ultrasonic dissection (LCSC5 Ultracision Maniple).
- Full-thickness rectal resections were performed, with defects closed using 3-0 polydoxanone sutures.
- Eighteen procedures were conducted: 9 for malignant and 9 for benign lesions.
Main Results:
- Median operating times were 92.5 minutes for malignant and 40 minutes for benign lesions.
- Two postoperative complications occurred: one bleeding event and one partial wound dehiscence.
- Median follow-up was 35 months for malignant and 19.5 months for benign disease, with no recurrences observed.
Conclusions:
- Modified TEM with the Storz rectoscope and ultrasonic dissection is suitable for rectal tumors up to 15 cm from the anal verge.
- The technique offers optimal coagulation and a bloodless field, significantly reducing equipment costs.
- Despite minor complications, the modified approach demonstrates efficacy and safety in rectal tumor resection.