Gustavo Seva-Pereira, MD, Vilmar L Trombeta, MD, Luis Gustavo C Romagnolo
Although Transanal Endoscopic Microsurgery (TEM) has been in use for more than 20 years, it has been slow to become universally adopted by colorectal surgeons, in part because of a long learning curve, but also because of the significant cost of the highly specialized equipment and instrumentation. Disposable single-port surgery devices became available and have been used for Transanal Minimally Invasive Surgery (TAMIS) with benefits, when compared to local resection and TEM.
A series of five patients with indication for local resection of rectal tumors were submited to surgery using the SSL™ device. Distance from anal verge was from 1 to 6cm and the tumor diameter was maximum 5cm. Four patients had an initial diagnosis of adenoma. One patient had a previous endoscopic resection of a T1 adenocarcinoma, resected with endoscopic mucosectomy technique with positive pathological margins. Two of the four resected tumors were early stage adenocarcinomas. All margins were free of tumor. One patient had a partial dehiscence of the suture line in distal rectum diagnosed on ninth post-operative day, and was treated without surgical re-intervention or other clinical measures.
Minimal setup time, low cost and specially the possibility of using regular laparoscopic instruments makes TAMIS a good option for transrectal or transanal resection. The results of this technique using this novel device are encouraging, concerning the feasability, manouverability, upfront cost, setup time, resecability of the lesion and low complication rate. Because of its potential instrumental simplicity and similarity with conventional laparoscopic surgery, it can be learned easily by surgeons not used to TEM technique.
Although at the present time the appropriate use of local excision is still under debate, TAMIS is a technique that still expects a lot of growing and much remains to be learned. As others, our group is optimistic that SSL™ will come as a good alternative to TEM and one of the most important contributions for transanal surgery for years.
Session: Poster Presentation
Program Number: ETP005