New Disposable Trans-Anal Access Platform: Longer Channel, Longer Reach

Elisabeth C McLemore, MD, Alisa Coker, MD, Sonia Ramamoorthy, MD, Garth Jacobsen, MD, Mark A Talamini, MD, Santiago Horgan

University of California, San Diego

Objective of the technology or device: The Gelpoint Path Long Channel is a longer, disposable, trans-anal access platform facilitating endoluminal surgical access to the upper rectum and distal colon. The longer channel is similar to the rigid trans-anal access platforms (TEM, TEO) and straightens out the rectum providing more reliable proximal access and visibility for the upper rectum and distal colon.

Description of the technology and method of its use or application: The Gelpoint Path Long Channel is 10 cm in length and 4 cm in width. The longer channel assists with trans-anal endoluminal proximal visibility and reach to remove lesions in the upper third of the rectum and distal sigmoid colon. The initial Gelpoint Path trans-anal access platform was not able to provide reliable visibility and surgical access greater than 10 cm from the dentate line. Using the longer channel device, trans-anal endoluminal surgical removal of lesions in the mid to upper rectum is more effectively performed. In addition, the longer channel facilitates better access for lesions that may be difficult to reach or visualize due to prominent rectal transverse folds or tumor location on the posterior aspect of the transverse rectal fold (Houston’s Valves).

Preliminary Results:
Three patients have undergone trans-anal minimally invasive surgical resection (TAMIS) of a rectal adenoma using the Gelpoint Path Long Channel by a single surgeon at a single institution. All patients were female, aged 51 – 53. Endoscopoic visualization was utilized in all three cases. TAMIS assisted with laparoscopic visualization was performed to ensure no peritoneal entry with TAMIS resection in two patients: a patient with a history of bone marrow transplantation for acute myelogenous leukemia (AML) and ongoing immunosuppressive therapy, and in an obese patient with a large, circumferential adenoma. Final pathology revealed adenoma with negative margins in all three cases. There were no complications. None of the patients have developed a local recurrence during the follow up period ranging from 1 – 6 months.

Table I: TAMIS Long Channel Peri-Operative Data

Age

Sex

BMI (kg/m2)

Tumor Locationa

Tumor Diameter

Operative Time

Hospital Length of Stay

Final Tumor Pathology

Margin

53 F 23 11 cm, Posterior 3 cm 57 min 3 days Adenoma Negative
51 F 32 3-9 cm, Circumferential 8.5 cm 262 min 2 days Adenoma Negative
51 F 24 10 cm, Anterior 2.4 cm 69 min 1 day Adenoma Negative

a – distance from dentate line
b – denotes eTAMIS (endoscopic visualization)
c – denotes TAMIS assisted with laparoscopic visualization

Conclusions/Future directions
The new trans-anal access device, Gelpoint Path Long Channel, facilitates trans-anal endoluminal surgical removal of lesions in the mid to upper rectum that may be difficult to reach using the standard disposable trans-anal access devices. We have successfully achieved 100% margin negative rate using this new device in patients with proximal rectal adenomas.


Session: Poster Presentation

Program Number: ETP064

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