Tems Using Single Port Instruments

Introduction: Recently, there is evolved many treatment modalities for early rectal cancer and rectal tumor. And transanal endoscopic microsurgery (TEMS) is raised primary concern in the field. But we need to special instrument specially designed for TEMS and surgeons have to be trained for special techniques to perform TEMS effectively. Heretofore, authors present a case of TEMS performed successfully with using single port larparoscopic surgical instruments. Methods and procedures: A multichannel single port was made with surgical glove (No. 6), one 10mm trocar, four 5mm trocars, one three-way catheter, and a wound retractor (Alexis, Applied Medical, Rancho Santa Margarita, CA). After patient was placed in the lithotomy position, then we inserted the wound retractor through the anus, and cover the single port made in advance over the wound retractor. Following insufflations of CO2 gas to a pressure of 12mmHg, through insufflation inlet of the trocar, full layer excision of rectal tumor was made. After successfully excised the rectal wall was secured by suture closure with laparoscopic instruments. Results: Patient is 71 year-old female who is diagnosed as lateral spreading rectal tumor which is located posterior rectal wall, 6 cm above anal verge and it’s size is measured as 4.0 x 3.5 cm. Authors performed TEMS for this patients without any complications and operation times are about 120 min. The pathologic result reveals tubular adenoma with high grade dysplasia. Conclusion: Transanal endoscopic microsurgery (TEMS) with single port instruments is efficient procedure for early rectal cancer and benign rectal tumor. Though it is not required specialized equipment as concerned, but experienced surgeon for laparoscopic surgery should be performed TEMS with single port instruments to reduce intraoperative or postoperative complications.

Session: Poster

Program Number: P244

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