UltraCision or high-frequency knife in transanal endoscopic microsurgery (TEM)? Advantages of a new procedure

The potential advantages of ultrasound dissection using UltraCision (UC), a n ultrasonically activated scalpel, rather than conventional electrosurgery (ES) were investigated retrospectively in 63 patients following transanal endoscopic microsurgery (TEM) in 22 cases of rectal carcinoma (16 pT1, four pT2, two pT3), 40 cases of rectal adenoma >2 cm, and one neurinoma. In all , 21 patients (13 adenomas, seven carcinomas, and one neurinoma) were opera ted with UltraCision (Ethicon, Norderstedt, Germany), whereas 42 patients ( 27 adenomas, 15 carcinomas) were treated with conventional electrocautery. All tumors were completely excised (R0) in both groups. We encountered a to tal of nine complications, seven after ES and two after UC use. Surgical re intervention was necessary in three cases (4.7%), exclusively following res ection by ES. There were five cases of tumor recurrence (7.9%), once again only in the ES group. The advantages of ultrasound dissection are magnified under the particular conditions of minimally invasive endoscopic rectum su rgery by means of TEM. In principle, all the known risks associated with th e application of electric current can be avoided by using ultrasound techno logy.