Surgical technique and outcome of gasless video endoscopic transanal rectal tumour excision

Abstract

Abstract Background Transanal endoscopic microsurgery (TEM) is unpopular because of its high cost and most surgeons' unfamiliarity with microscopic surgery. This report describes an experience with a modification of TEM, gasless video endoscopic transanal rectal tumour excision (gasless VTEM), which incorporates a standard laparoscopic video camera and requires no carbon dioxide insufflation system. Methods One hundred and one patients with 105 rectal tumours underwent gasless VTEM between 1993 and 2000. Results Histological examination revealed 18 adenomas, 75 carcinomas (Tis, 47; T1, 23; T2, five), 11 carcinoid tumours and one lymphoma. The median height above the dentate line and maximum tumour diameter was 5·0 (range 2–14) cm and 2·0 (range 0·4–8·0) cm respectively. The peritoneal cavity was opened intraoperatively in two patients. The median operating time was 53 (range 15–202) min. Bleeding, suture dehiscence and transient incontinence developed after operation in four patients. There was no operative death. Median hospital stay was 5 (range 1–21) days. Eleven patients with T1/T2 staging underwent subsequent radical resection. The median duration of follow-up was 52·3 months. One patient with a carcinoma developed a recurrence. Conclusion Gasless VTEM is a feasible, safe and minimally invasive procedure for the treatment of selected rectal adenomas and early carcinomas. The suggested modifications may make the procedure more widely available.