Dynamic Article: Transanal Rectal Excision: A Pilot Study

作者：Wolthuis Albert M^*; van Overstraeten Anthony de Buck; D'Hoore Andre

来源：Diseases of the Colon & Rectum, 2014, 57(1): 105-109.

DOI：10.1097/DCR.0000000000000008

• Rectal surgery
• Transanal
• Total mesorectal excision
• Transanal minimally invasive surgery

BACKGROUND: Laparoscopic total mesorectal excision can be difficult in a narrow pelvis. Transanal minimally invasive surgery allows the surgeon to mobilize the most distal part of the rectum by using a single port positioned in the anal canal.
OBJECTIVE: We aim to assess the safety and feasibility of transanal rectal excision.
DESIGN AND SETTING: This pilot study was conducted in a university hospital and tertiary colorectal referral center in Belgium.
PATIENTS: Over a 12-month period, all consecutive patients with benign disease and ASA grade 3 patients with a rectal carcinoma who required either intersphincteric proctectomy or coloanal anastomosis were included.
INTERVENTION: After intersphincteric dissection or sleeve mucosectomy, a single-access multichannel port was inserted into the anal canal. A transanal rectal excision was performed by using conventional laparoscopic instruments. The planes were developed as cephalad as possible, until the pouch of Douglas was opened. A laparoscopically assisted approach was used to gain bowel length and was used in patients who required proctectomy. In the case of a reconstruction, a handsewn coloanal anastomosis was made.
MAIN OUTCOME MEASURES: Intraoperative challenges, conversion rate, operating time, blood loss, morbidity, and length of stay were assessed.
RESULTS: Fourteen patients underwent a transanal rectal excision for both benign (9) and malignant (5) disease. In 11 patients (79%), laparoscopically assisted transanal minimally invasive rectal excision was performed. The median (range) transanal operating time was 55 (35-95) minutes. Intraoperative difficulties hindering dissection occurred in 5 patients and were due to inadequate exposure, rectal perforation, or fibrosis secondary to radiotherapy for prostate cancer. There was minimal postoperative morbidity, with a median follow-up of 6.3 (1.5-13.8) months. All patients were discharged within 14 days postoperatively, and there were no readmissions.
LIMITATIONS: The study was limited by the small number of patients.
CONCLUSION: Transanal rectal excision is safe and feasible and could be a promising technique to facilitate distal rectal mobilization (see Video, Supplemental Digital Content 1, http://links.lww.com/DCR/A125).

• 出版日期2014-1