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DOI: 10.1055/s-0034-1377545
Transanal submucosal endoscopic resection: a new endosurgical approach to the resection of giant rectal lesions
Publication History
Publication Date:
25 September 2014 (online)
Transanal surgical and advanced endoscopic resection procedures have the potential to provide complete and successful eradication of rectal lesions [1] [2] [3]. However, both approaches have limitations in terms of practicability and safety [3] [4] [5].
Transanal submucosal endoscopic resection (TASER) is a new endosurgical approach, which combines the advantages of both endoscopic therapy and transanal surgery. It utilizes a three-port channel platform (GelPoint Path; Applied Medical, Rancho Santa Margarita, California, USA), which allows simultaneous transanal passage of an endoscope and two laparoscopic instruments ([Fig. 1]).
We present a video clip demonstrating TASER, where an endoscopic knife is used as the primary cutting tool to resect a (9.4 × 7.6 cm) circumferential (abutting the dentate line to the upper rectum), benign, nongranular, lateral spreading tumor ([Fig. 2]).
A 2-mm lateral resection margin around the lesion was maintained during circumferential mucosal incision. The GelPoint Path system was then mounted across the anal canal and a surgeon passed two laparoscopic forceps retractors (Johann Forceps 33 cm; Karl Storz, Tuttlingen, Germany) into the rectum, working alongside the endoscopist who passed a gastroscope through the third port; both operators utilized the endoscopic view. Once a tissue flap had been created, the submucosal dissection was rapid, using long sweeping movements of the endoscopic knife (FlushKnife BT, 1.5 mm; Fujifilm, Tokyo, Japan) parallel to the underlying muscle. Repeated injections expanded the submucosal plane and sustained a clear separation of the submucosal and muscle layers. The retractors could be repositioned multiple times and in any direction, providing the endoscopist with a continuous view of the submucosal plane ([Video 1]). The en bloc resection was completed in 182 minutes. Large vessels were coagulated and clipped to prevent delayed bleeding.
Quality:
After a 6-month interval, a check-up endoscopy showed a healed scar with no signs of recurrence or rectal stricture ([Fig. 3]).
The TASER approach appears to be technically easier and fundamentally safer than conventional transanal surgery and advanced endoscopic therapy for the resection of giant (> 5 cm) rectal polyps.
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References
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- 5 Arezzo A, Passera R, Saito Y et al. Systematic review and meta-analysis of endoscopic submucosal dissection versus transanal endoscopic microsurgery for large noninvasive rectal lesions. Surg Endosc 2014; 28: 427-438