Presented orally at the 15th International Congress at the European Association of Endoscopic Surgery in Athena, Greece, July 5th 2007.
Previous research indicates that application of 5-mm harmonic shears rather than diathermia significantly reduces operation time in transanal endoscopic microsurgery (TEM). Frequently, however, additional instruments were required to complete resection. We investigated whether the new 5-mm harmonic long shears (H-LS) are better equipped for TEM compared with regular harmonic shears (HS).
Between 2001 and 2006, 162 tumors (117 adenomas, 42 carcinomas, and 3 other tumors; mean distance 6.6 cm, mean area 40 cm2) were excised in 161 patients (82 men, 79 women; mean age 66 years).
Eighty-eight resections were performed with HS and 74 with H-LS. Tumor and patient characteristics were similar except for specimen area. Tumors resected by H-LS were on average smaller than those resected by HS (34.4 versus 44.1 cm2; Mann–Whitney U-test: p = 0.027). Mean operation time was 48 min and proportional to area in both groups (univariate analysis of variance p < 0.001). Mean operation time was 54 min using HS and 41 min using H-LS (t-test: p < 0.001). After correction for area, operation time for H-LS was reduced by 14% compared with HS (t-test: p < 0.001). H-LS is singly capable of completing resection in 88% compared with 26% for HS (Mann–Whitney U-test: p < 0.001). Mean blood loss was 16 cc for HS and 3 cc for H-LS (p < 0.001). Morbidity (11%) and mortality (0.6%) were not different between the two groups (Fisher’s exact test).
Performing transanal endoscopic microsurgery with 5-mm harmonic long shears reduces operation time compared with regular shears, and completing resection seldom requires other instruments.
Buess G, Theiss R, Hutterer F, Pichlmaier H, Pelz C, Holfeld T, Said S, Isselhard W (1983) Transanal endoscopic surgery of the rectum—testing a new method in animal experiments. Leber Magen Darm 13:73–77 PubMed
Said S, Stippel D (1996) 10 years experiences with transanal endoscopic microsurgery. Histopathologic and clinical analysis. Chirurg 67:139–144 PubMed
Buess G (1993) Review: transanal endoscopic microsurgery (TEM). J R Coll Surg Edinb 38:239–245 PubMed
Lezoche E, Guerrieri M, Paganini A, Feliciotti F, Di Pietrantonj F (1996) Is transanal endoscopic microsurgery (TEM) a valid treatment for rectal tumors? Surg Endosc 10:736–741 PubMed
Gossot D (1998) Ultrasonic dissectors in endoscopic surgery. Ann Chir 52:635–642 PubMed
Protell RL, Gilbert DA, Silverstein FE, Jensen DM, Hulett FM, Auth DC (1981) Computer-assisted electrocoagulation: bipolar vs. monopolar in the treatment of experimental canine gastric ulcer bleeding. Gastroenterology 80:451–455 PubMed
Nduka CC, Super PA, Monson JR, Darzi AW (1994) Cause and prevention of electrosurgical injuries in laparoscopy. J Am Coll Surg 179:161–170 PubMed
Kanehira E, Raestrup H, Schurr MO, Wehrmann M, Manncke K, Buess GF (1993) Transanal endoscopic microsurgery using a newly designed multifunctional bipolar cutting and monopolar coagulating instrument. Endosc Surg Allied Technol 1:102–106 PubMed
Farin G (1993) Pneumatically controlled bipolar cutting instrument. Endosc Surg Allied Technol 1:97–101 PubMed
Salm R, Lampe H, Bustos A, Matern U (1994) Experience with TEM in Germany. Endosc Surg Allied Technol 2:251–254 PubMed
Bennett CL, Stryker SJ, Ferreira MR, Adams J, Beart RW Jr (1997) The learning curve for laparoscopic colorectal surgery. Preliminary results from a prospective analysis of 1194 laparoscopic-assisted colectomies. Arch Surg 132:41–44; discussion 45 PubMed
- Harmonic long shears further reduce operation time in transanal endoscopic microsurgery
Pleun E. A. Hermsen
Ifesegun D. Ayodeji
Wim H. C. Hop
Geert W. M. Tetteroo
Eelco J. R. de Graaf
Neu im Fachgebiet Chirurgie
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