CLINICAL USE OF A FRONT LIFTING HOOD RECTOSCOPE TUBE FOR TRANSANAL ENDOSCOPIC MICROSURGERY

Background: Transanal endoscopic microsurgery (TEM), a procedure devel oped by Buess et al. requires a specially designed surgical rectoscope system, and adequate training for its operation is mandatory. In orde r to simplify the performance of TEM, and to allow the use of addition al surgical instruments and devices, we have developed a new rectoscop e tube. Methods: The forward half of the tube can be opened longitudin ally by hand, Our working insert platform is hollowed and includes a c hannel for an endoscope. The resection procedure can be performed unde r normal atmospheric pressure. This newly developed rectoscope system has already been employed clinically. TEM was performed using our orig inal forward lifting hood rectoscope tube in 20 patients, including 12 cases of sessile adenoma and eight cases of early carcinoma. Results: The forward hood of the tube was opened to the maximum angle of 25 de grees in eight patients and 15-20 degrees in the other 12 patients, Th e visible field of the rectal interior was extended in direct proporti on to the angle. Through our working insert platform, instruments and devices could be used for either laparoscopic or open surgery. Conclus ions: These modifications have made TEM easier and will therefore make the procedure available to more surgeons.