Rectal expander-assisted transanal endoscopic microsurgery in rectal tumors

Area of Science:

• Surgical Oncology
• Gastroenterology
• Minimally Invasive Surgery

Background:

• Local excision is a standard treatment for early rectal cancer.
• Traditional endoscopic methods may have limitations in visualization and reach for certain rectal tumors.
• Transanal endoscopic microsurgery (TEM) offers improved visualization but can be challenging in narrow or tortuous rectal anatomy.

Purpose of the Study:

• To introduce and evaluate a novel technique, rectal expander-assisted transanal endoscopic microsurgery (RE-TEM).
• To assess the feasibility and efficacy of RE-TEM for local excision of rectal tumors.
• To determine if RE-TEM can overcome limitations of standard endoscopic and TEM procedures.

Main Methods:

• RE-TEM was performed on three patients: two with early rectal cancer and one with a villous tumor.
• A custom-developed rectal expander was used to facilitate rectal lumen expansion and visualization.
• Procedures were conducted under saddle block anesthesia, with tumors located 5-8 cm from the anal verge.

Main Results:

• All three tumors were completely excised without difficulty using the RE-TEM technique.
• Minor bleeding occurred in all cases but was effectively managed with electrocoagulation and/or sutures.
• The average operative time for the three RE-TEM procedures was 105 minutes.

Conclusions:

• RE-TEM is a feasible and effective technique for the local excision of rectal tumors.
• The rectal expander facilitates adequate visualization for microsurgery, improving upon standard TEM.
• RE-TEM is a valuable option for rectal tumors and early rectal cancers not amenable to endoscopic removal.