This is the Scientific Surgery Archive, which contains all randomized clinical trials in surgery that have been identified by searching the top 50 English language medical journal issues since January 1998. Compiled by Jonothan J. Earnshaw, former Editor-in-Chief, BJS
Transanal glove port is a safe and cost‐effective alternative for transanal endoscopic microsurgery. BJS 2012; 99: 1429-1435.
Published: 7th September 2012
Authors: R. Hompes, F. Ris, C. Cunningham, N. J. Mortensen, R. A. Cahill
Background
Transanal endoscopic microsurgery (TEM) is a minimally invasive technique for excision of rectal tumours that avoids conventional pelvic resectional surgery along with its risks and side‐effects. Although appealing, the associated cost and complex learning curve limit TEM utilization by colorectal surgeons. Single‐port laparoscopic principles are being recognized as transferable to transanal work and hybrid techniques are in evolution. Here the clinical application of a new technique for transanal access is reported.
Method
Consecutive non‐selected patients eligible for TEM over a 3‐month period (and selected patients thereafter) were offered a procedure performed via a ‘glove TEM port’. This access device was constructed on‐table using a circular anal dilator (CAD), wound retractor and standard surgical glove, along with standard, straight laparoscopic trocar sleeves and instruments.
Results
Fourteen patients underwent full‐thickness resection of benign (8) or malignant (6) rectal pathology. CAD insertion failed in one patient and conventional TEM assistance was needed in another, leaving 12 procedures completed successfully by glove TEM alone as planned (completion rate 86 per cent overall, 92 per cent after initiation). The median (range) duration of operation and resected specimen area were 93 (30–120) min and 12 (3–152) cm2 respectively. There was no intraoperative and minimal postoperative morbidity, with a median follow‐up of 5·7 (2·7–9·4) months.
Conclusion
The glove TEM port is a safe, inexpensive and readily available access tool that may obviate the use of specialized equipment for transanal resection of rectal lesions. Copyright © 2012 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.
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