Transanal Endoscopic Microsurgery (tem) with Single Port Instruments

HJ Kim, BH Kye, HM Cho, SC Lee, JH Kim, IK Lee, YS Lee, ST Oh, JG Kim. St. Vincent’s Hospital, The Catholic University of Korea

INTRODUCTION: Recently, there is evolved many treatment modalities for early rectal cancer and benign rectal tumor. And transanal endoscopic microsurgery (TEM) is raised primary concern in the field. But we need special instruments specially designed for TEM and surgeons have to be trained for special techniques to perform TEM effectively. Heretofore, authors present our experiences of TEM performed successfully with single port laparoscopic surgical instruments. METHODS AND PROCEDURES: From July 2009 to July 2010, eight patients with rectal tumor were treated with TEM using single port instruments. We have used a multichannel single port made with surgical glove (No. 6), one 10mm trocar, three 5mm trocars, one three-way catheter and a wound retractor (Alexis, Applied Medical, Rancho Santa Margarita, CA) or the SILS port (Covidien). The patient was placed in the lithotomy position for posterior located tumor and in the prone position for anterior located tumor, then we inserted either the wound retractor through the anus and cover the single port made in advance over the wound retractor, or SILS port through the anus. Following insufflations of CO2 gas to a pressure of 12mmHg, through insufflation inlet of the trocar, full layer excision of rectal lesion was made. After full thickness excision, the rectal wall was secured by interrupted suture closure with conventional laparoscopic instruments including knot pusher. RESULTS: Three male and five female patients with the mean age 66 (54-76) years were performed TEM with single port instruments. The mean BMI was 25.0 kg/m². The mean location of the tumor from the anal verge was 8.6 (6-13) cm, and five tumors were located at posterior side, and others were located at anterior, right, and left side, respectively. The mean tumor size was 2.8 (2-4) cm. and the mean operating time was 115.1 (40-175) min. Histological examination revealed one adenocarcinoma invades lamina propria (Tis), one chronic inflammation, one no residual malignancy and others were tubular adenoma with high grade dysplasia with negative resection margin in all cases. There were no intraoperative or postoperative complications. CONCLUSION: Transanal endoscopic microsurgery (TEM) with single port instruments is efficient procedure for early rectal cancer and benign rectal tumor. For this procedure, special equipments are not required, and surgeons who are familiar with laparoscopic surgery could perform TEM with single port instruments, efficiently.