MICROSCOPIC ENDOLUMINAL TUMORECTOMY

PURPOSE: We herein report our experience with transanal endoscopic mic rosurgery. The new technique combines an endoscopic view and access of the rectum under gas insufflation via a stereoscopic telescope with a ll conventional surgical maneuvers such as tissue preparation, coagula tion and control of bleeding, irrigation, suction, and, finally, sutur ing of the parietal defect. METHODS: The main indication for transanal endoscopic microsurgery is the removal of broad-based sessile polyps and excision of early rectal cancers. We performed local excision of p T2, G1-2 adenocarcinomas and excision of advanced rectal cancer in hig h-risk patients. The reported series includes 35 consecutive patients, who have been enrolled in a prospective clinical trial. Five patients were excluded for different reasons. The patients were submitted to 2 9 total wall excisions with or without perirectal fat and one mucosect omy. RESULTS: Postoperative histologic examination showed 9 adenomas a nd 21 adenocarcinomas. Morbidity included 2 (5.6 percent) perioperativ e and 2 (5.6 percent) late complications. There was no operative morta lity and the mean postoperative hospital course was six days. All pati ents are in follow-up observation with a mean time of 10.3 months. In the group of adenomas and adenocarcinomas, we did not observe local re currence. CONCLUSIONS: Considering our experience with the overall res ults reported by other authors, we believe that transanal endoscopic m icrosurgery is the procedure of choice for the treatment of rectal pol yps and early rectal cancers provided strict patient selection criteri a are met.