Total laparoscopic sigmoid and rectal surgery combined with transanal endoscopic microsurgery / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the feasibility and short-term outcomes of total laparoscopic sigmoid and rectal surgery combined with transanal endoscopic microsurgery(TEM).</p><p><b>METHODS</b>The clinical data of 26 patients with colorectal carcinoma treated by total laparoscopic surgery with TEM between May 2010 and May 2011 in the Shanghai Ruijin Hospital were retrospectively analyzed.</p><p><b>RESULTS</b>All the 26 operations were successfully accomplished laparoscopically. There was no conversion to open procedure. No diverting ileostomy was made. The mean operative time was (151.6±25.9) min. The mean blood loss was (200.2±114.7) ml. The mean time to first flatus was (2.0±0.5) d. The mean tumor size was (3.0±0.7) cm and all resection margins were negative. The mean number of lymph nodes harvested was (12.9±2.2). Six patients developed postoperative anastomotic leakage, all of who had tumors in the lower rectum. There were no ureteral injury, intestinal obstruction, or pulmonary infection.</p><p><b>CONCLUSIONS</b>Total laparoscopic sigmoid and rectal surgery combined with TEM is a safe and feasible minimally invasive surgery. It is an improvement by combining laparoscopic skills with the concept of natural orifice transluminal endoscopic surgery.</p>

Analysis of 32 patients with rectal adenoma undergoing transanal endoscopic microsurgery / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the safety and outcomes after transanal endoscopic microsurgery (TEM)for rectal adenoma.</p><p><b>METHODS</b>Data of 32 patients undergoing TEM for rectal adenoma between September 2006 and February 2010 in the Ruijin Hospital were reviewed.</p><p><b>RESULTS</b>The adenoma diameter ranged from 0.6 to 10.0(2.3±1.2) cm. The mean operative time was 70(range,20-180) min. The estimated blood loss was less than 10 ml. There were no conversions to transabdominal procedure. Twenty-two(68.8%) patients underwent suturing of the wound, of whom 14 had full-thickness resection. Two patients had perforation into peritoneal cavity during full-thickness resection, which were repaired by continuous suturing and no postoperative leak occurred. R0 resection was achieved in 31(96.9%) patients. Postoperative pathology showed 12 simple adenomas, 10 adenomas with low grade intraepithelial neoplasia, 5 adenomas with high grade intraepithelial neoplasia, and 5 T1 focal carcinomas. Complications included rectal bleeding in 1 patient, acute urinary retention in 1 patient, and pulmonary infection in 1 patient. The postoperative stay was 4.5(3-8) days. The patients were followed-up for a period of 23 months(range, 2-43 months). There were 2 tumors recurred.</p><p><b>CONCLUSION</b>TEM is a safe and effective minimally invasive surgical technique for large rectal adenomas.</p>