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Harmonic scalpel in transanal microsurgery.

Nikica Druzijanić1, Zdravko Perko, Damir Kraljević

  • 1Department of Surgery, University Hospital Split, Split, Croatia. ndruzija@kbsplit.hr

Hepato-Gastroenterology
|July 11, 2008
PubMed
Summary

Transanal endoscopic microsurgery (TEM) with Ultracision is effective for rectal tumors. This technique offers a precise, bloodless surgical field, leading to no reported morbidity or mortality in patients with benign or early-stage malignant rectal tumors.

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Area of Science:

  • Colorectal Surgery
  • Minimally Invasive Surgery
  • Oncology

Background:

  • Transanal endoscopic microsurgery (TEM) is a minimally invasive technique for rectal tumor removal.
  • The use of Ultracision (harmonic scalpel) in TEM procedures warrants investigation for its safety and efficacy.

Purpose of the Study:

  • To evaluate the outcomes of transanal endoscopic microsurgery (TEM) using Ultracision for rectal tumors.
  • To assess the safety, precision, and effectiveness of the harmonic scalpel in TEM procedures.

Main Methods:

  • Retrospective analysis of 54 patients undergoing TEM for middle and distal rectal tumors between 1997 and 2006.
  • Tumors treated included benign conditions and early-stage (T1N0M0, T2N0M0) well or moderately differentiated adenocarcinomas.
  • Excision was performed using Ultracision harmonic scalpel following submucosal infiltration with epinephrine and lidocaine.

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Main Results:

  • No operative morbidity or mortality was observed in the study cohort.
  • Histopathological analysis revealed various benign and malignant rectal tumors, including adenomas and adenocarcinomas.
  • No local recurrence was reported during the follow-up period, with 8 patients receiving adjuvant radiotherapy.

Conclusions:

  • Transanal endoscopic microsurgery (TEM) is a preferred treatment for benign rectal tumors and T1N0M0, grade 1-2 malignant rectal tumors.
  • The harmonic scalpel enhances surgical precision, providing a cleaner, bloodless operative field for improved outcomes in TEM.