Harmonic long shears further reduce operation time in transanal endoscopic microsurgery

Area of Science:

• Colorectal Surgery
• Minimally Invasive Procedures
• Surgical Instrumentation

Background:

• Transanal endoscopic microsurgery (TEM) often requires additional instruments when using standard 5-mm harmonic shears (HS).
• Previous research suggests HS reduce operation time compared to diathermia in TEM.
• The efficacy of new 5-mm harmonic long shears (H-LS) for TEM has not been fully evaluated.

Purpose of the Study:

• To compare the effectiveness of 5-mm harmonic long shears (H-LS) versus regular harmonic shears (HS) in transanal endoscopic microsurgery (TEM).
• To assess the impact of H-LS on operation time, completeness of resection, and blood loss during TEM.

Main Methods:

• A retrospective study comparing 162 tumor excisions in 161 patients undergoing TEM between 2001 and 2006.
• Eighty-eight resections were performed using HS, and 74 using H-LS.
• Patient and tumor characteristics were analyzed, with a focus on operation time, blood loss, and resection completeness.

Main Results:

• Tumors resected with H-LS were smaller on average (34.4 cm²) than those with HS (44.1 cm²).
• Mean operation time was significantly reduced with H-LS (41 min) compared to HS (54 min), a 14% reduction after area correction.
• H-LS achieved complete resection in 88% of cases, versus 26% for HS. Blood loss was also significantly lower with H-LS (3 cc vs. 16 cc).

Conclusions:

• 5-mm harmonic long shears (H-LS) are more effective than regular harmonic shears (HS) for transanal endoscopic microsurgery (TEM).
• H-LS reduce operation time and blood loss, and facilitate complete tumor resection, often without requiring additional instruments.
• The findings support the use of H-LS for improved efficiency and outcomes in TEM procedures.