Clinical analysis of laparoscopic microsurgery by transanal glove port for excision of rectal tumor_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

DING Chuang ,  CHEN Yan , ZHU Xinqiang , ZHANG Ming

Department of General Surgery, Suqian People’s Hospital of Nanjing Drum-Tower Hospital Group, Suqian, Jiangsu 223800, P.R.China;

Corresponding author：

CHEN Yan, Email: sqchenyan@126.com

Keywords：

rectal tumor; transanal golve port; laparoscope

DOI：

10.7507/1007-9424.201606026

Video：

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Objective To explore feasibility and efficacy of laparoscopic microsurgery by transanal glove port for excision of rectal tumor. Methods Seventeen patients with rectal tumor underwent laparoscopic microsurgery by transanal glove port for local excision of rectal tumor were chosen from March 2015 to March 2016. This device was constructed by using a incision protective sleeve and standard surgical glove. The laparoscopy was used as lighting equipment. The ultrasonic scalpel, operation forceps and lens were separately inserted into the fixed sheath card from the 3 finger gloves. Results The operations of 17 cases were completed successfully. The operative time was 35–90 min with an average 54 min. The closed glove access time was 11 to 26 min with an average 18 min. The diameter of tumor was 1.4–3.5 cm with an average 2.4 cm. The results of postoperative pathology included 8 cases of villos adenemas, 3 cases of high-grade intraepithelial neoplasia, 1 case of low-grade intraepithelial neoplasia, 3 cases of carcinoid , and 2 cases of adenocarcinoma. All resection margins were negative. No infection, intestinal fistula, bleeding, and other complications were found. The hospital stay was 4–9 d with an average of 5 d. No recurrence was found during a follow-up of 1–6 months. Conclusions The preliminary results of limited cases in this study show that laparoscopic microsurgery by transanal glove port for excision of rectal tumor is easy, safe, and effective. It also provides a new choice for individualized comprhensive treatment of rectal tumor.

Citation： DINGChuang, CHENYan, ZHUXinqiang, ZHANGMing. Clinical analysis of laparoscopic microsurgery by transanal glove port for excision of rectal tumor. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2017, 24(2): 244-247. doi: 10.7507/1007-9424.201606026 Copy

1.	de Graaf EJ, Burger JW, van Ijsseldijk AL,et al. Transanal endoscopic microsurgery is superior to transanal excision of rectal adenomas. Colorectal Dis, 2011, 13(7): 762-767.
2.	茅伟明, 廖秀军, 杨关根, 等. 经肛门内镜显微手术治疗直肠肿瘤 25 例. 中华普通外科杂志, 2010, 25(11): 937-938.
3.	Moore JS, Cataldo PA, Osler T,et al. Transanal endoscopic microsurgery is more effective than traditional transanal excision for resection of rectal masses. Dis Colon Rectum, 2008, 51(7): 1026-1031.
4.	Zhang H, Zhang YS, Jin XW,et al. Transanal single-port laparoscopic total mesorectal excision in the treatment of rectal cancer. Tech Coloproctol, 2013, 17(1): 117-123.
5.	贺长林, 杨康, 李鸿, 等. 腹腔镜下直肠癌根治术的临床应用. 中国普外基础与临床杂志, 2012, 19(1): 107-108.
6.	Baek JH, Lee GJ, Lee WS. Comparison of long-term oncologic outcomes of stage Ⅲ colorectal cancer following laparoscopicversus open surgery. Ann Surg Treat Res, 2015, 88(1): 8-14.
7.	Hompes R, Ris F, Cunningham C,et al. Transanal glove port is a safe and cost-effective alternative for transanal endoscopic microsurgery. Br J Surg, 2012, 99(10): 1429-1435.
8.	Barendse RM, van den Broek FJ, Dekker E,et al. Systematic review of endoscopic mucosal resectionversus transanal endoscopic microsurgery for large rectal adenomas. Endoscopy, 2011, 43(11): 941-949.
9.	Allaix ME, Arezzo A, Cassoni P,et al. Recurrence after transanal endoscopic microsurgery for large rectal adenomas. Surg Endosc, 2012, 26(9): 2594-2600.
10.	Scala A, Gravante G, Dastur N,et al. Transanal endoscopic microsurgery in small, large, and giant rectal adenomas. Arch Surg, 2012, 147(12): 1093-1100.
11.	Wu Y, Wu YY, Li S,et al. TEM and conventional rectal surgery for T1 rectal cancer: a meta-analysis. Hepatogastroenterology, 2011, 58(106): 364-368.
12.	郭潇繁, 许海楠, 王振宁. 经肛门内窥镜下微创手术与传统根治术治疗直肠癌疗效与安全性的系统评价. 中国循证医学杂志, 2011, 11(1): 70-75.
13.	Heintz A, Mörschel M, Junginger T. Comparison of results after transanal endoscopic microsurgery and radical resection for T1 carcinoma of the rectum. Surg Endosc, 1998, 12(9): 1145-1148.
14.	Bach SP, Hill J, Monson JR,et al. A predictive model for local recurrence after transanal endoscopic microsurgery for rectal cancer. Br J Surg, 2009, 96(3): 280-290.
15.	Serra-Aracil X, Mora-Lopez L, Alcantara-Moral M,et al. Transanal endoscopic surgery in rectal cancer. World J Gastroenterol, 2014, 20(33): 11538-11545.
16.	李方, 钟克力, 陈杰, 等. 经肛门内镜微创手术的临床应用现状及前景展望. 中华腔镜外科杂志, 2014, 7(4): 326-329.
17.	Gavagan JA, Whiteford MH, Swanstrom LL. Full-thickness intraperitoneal excision by transanal endoscopic microsurgery does not increase short-term complications. Am J Surg, 2004, 187(5): 630-634.
18.	Eyvazzadeh DJ, Lee JT, Madoff RD,et al. Outcomes after transanal endoscopic microsurgery with intraperitoneal anastomosis. Dis Colon Rectum, 2014, 57(4): 438-441.
19.	You YN, Baxter NN, Stewart A,et al. Is the increasing rate of local excision for stage Ⅰ rectal cancer in the United States justified?: a nationwide cohort study from the National Cancer Database. Ann Surg, 2007, 245(5): 726-733.
20.	徐协群, 邱辉忠. 直肠癌的局部切除. 中国实用外科杂志, 2007, 27(6): 495-497.
21.	韩方海, 张肇达, 詹文华, 等. 直肠癌保肛手术. 北京: 人民卫生出版社, 2009: 258-260.
22.	Mellgren A, Sirivongs P, Rothenberger DA,et al. Is local excision adequate therapy for early rectal cancer? Dis Colon Rectum, 2000, 43(8): 1064-1074.
23.	Benoist S, Panis Y, Martella L,et al. Local excision of rectal cancer for cure: should we always regard rigid pathologic criteria? Hepatogastroenterology, 1998, 45(23): 1546-1551.
24.	宁勇, 陈跃宇. 腹腔镜与内镜双镜联合在直肠癌治疗中的应用进展. 中国普外基础与临床杂志, 2015, 22(4): 499-503.
25.	Duek SD, Issa N, Hershko DD,et al. Outcome of transanal endoscopic microsurgery and adjuvant radiotherapy in patients with T2 rectal cancer. Dis Colon Rectum, 2008, 51(4): 379-384.
26.	梁建伟, 王征, 周志祥, 等. 低位直肠癌局部切除术后复发因素分析. 中华胃肠外科杂志, 2009, 12(1): 36-39.
27.	林国岳, 邱辉忠, 周皎琳, 等. 经肛门内镜微创手术的适应症与并发症. 中华结直肠疾病电子杂志, 2015, 4(5): 521-525.
28.	邓群, 廖秀军, 杨关根, 等. 经肛手套通路联合结肠镜微创手术治疗直肠肿瘤. 中华胃肠外科杂志, 2014, 17(5): 473-475.

1. de Graaf EJ, Burger JW, van Ijsseldijk AL,et al. Transanal endoscopic microsurgery is superior to transanal excision of rectal adenomas. Colorectal Dis, 2011, 13(7): 762-767.
2. 茅伟明, 廖秀军, 杨关根, 等. 经肛门内镜显微手术治疗直肠肿瘤 25 例. 中华普通外科杂志, 2010, 25(11): 937-938.
3. Moore JS, Cataldo PA, Osler T,et al. Transanal endoscopic microsurgery is more effective than traditional transanal excision for resection of rectal masses. Dis Colon Rectum, 2008, 51(7): 1026-1031.
4. Zhang H, Zhang YS, Jin XW,et al. Transanal single-port laparoscopic total mesorectal excision in the treatment of rectal cancer. Tech Coloproctol, 2013, 17(1): 117-123.
5. 贺长林, 杨康, 李鸿, 等. 腹腔镜下直肠癌根治术的临床应用. 中国普外基础与临床杂志, 2012, 19(1): 107-108.
6. Baek JH, Lee GJ, Lee WS. Comparison of long-term oncologic outcomes of stage Ⅲ colorectal cancer following laparoscopicversus open surgery. Ann Surg Treat Res, 2015, 88(1): 8-14.
7. Hompes R, Ris F, Cunningham C,et al. Transanal glove port is a safe and cost-effective alternative for transanal endoscopic microsurgery. Br J Surg, 2012, 99(10): 1429-1435.
8. Barendse RM, van den Broek FJ, Dekker E,et al. Systematic review of endoscopic mucosal resectionversus transanal endoscopic microsurgery for large rectal adenomas. Endoscopy, 2011, 43(11): 941-949.
9. Allaix ME, Arezzo A, Cassoni P,et al. Recurrence after transanal endoscopic microsurgery for large rectal adenomas. Surg Endosc, 2012, 26(9): 2594-2600.
10. Scala A, Gravante G, Dastur N,et al. Transanal endoscopic microsurgery in small, large, and giant rectal adenomas. Arch Surg, 2012, 147(12): 1093-1100.
11. Wu Y, Wu YY, Li S,et al. TEM and conventional rectal surgery for T1 rectal cancer: a meta-analysis. Hepatogastroenterology, 2011, 58(106): 364-368.
12. 郭潇繁, 许海楠, 王振宁. 经肛门内窥镜下微创手术与传统根治术治疗直肠癌疗效与安全性的系统评价. 中国循证医学杂志, 2011, 11(1): 70-75.
13. Heintz A, Mörschel M, Junginger T. Comparison of results after transanal endoscopic microsurgery and radical resection for T1 carcinoma of the rectum. Surg Endosc, 1998, 12(9): 1145-1148.
14. Bach SP, Hill J, Monson JR,et al. A predictive model for local recurrence after transanal endoscopic microsurgery for rectal cancer. Br J Surg, 2009, 96(3): 280-290.
15. Serra-Aracil X, Mora-Lopez L, Alcantara-Moral M,et al. Transanal endoscopic surgery in rectal cancer. World J Gastroenterol, 2014, 20(33): 11538-11545.
16. 李方, 钟克力, 陈杰, 等. 经肛门内镜微创手术的临床应用现状及前景展望. 中华腔镜外科杂志, 2014, 7(4): 326-329.
17. Gavagan JA, Whiteford MH, Swanstrom LL. Full-thickness intraperitoneal excision by transanal endoscopic microsurgery does not increase short-term complications. Am J Surg, 2004, 187(5): 630-634.
18. Eyvazzadeh DJ, Lee JT, Madoff RD,et al. Outcomes after transanal endoscopic microsurgery with intraperitoneal anastomosis. Dis Colon Rectum, 2014, 57(4): 438-441.
19. You YN, Baxter NN, Stewart A,et al. Is the increasing rate of local excision for stage Ⅰ rectal cancer in the United States justified?: a nationwide cohort study from the National Cancer Database. Ann Surg, 2007, 245(5): 726-733.
20. 徐协群, 邱辉忠. 直肠癌的局部切除. 中国实用外科杂志, 2007, 27(6): 495-497.
21. 韩方海, 张肇达, 詹文华, 等. 直肠癌保肛手术. 北京: 人民卫生出版社, 2009: 258-260.
22. Mellgren A, Sirivongs P, Rothenberger DA,et al. Is local excision adequate therapy for early rectal cancer? Dis Colon Rectum, 2000, 43(8): 1064-1074.
23. Benoist S, Panis Y, Martella L,et al. Local excision of rectal cancer for cure: should we always regard rigid pathologic criteria? Hepatogastroenterology, 1998, 45(23): 1546-1551.
24. 宁勇, 陈跃宇. 腹腔镜与内镜双镜联合在直肠癌治疗中的应用进展. 中国普外基础与临床杂志, 2015, 22(4): 499-503.
25. Duek SD, Issa N, Hershko DD,et al. Outcome of transanal endoscopic microsurgery and adjuvant radiotherapy in patients with T2 rectal cancer. Dis Colon Rectum, 2008, 51(4): 379-384.
26. 梁建伟, 王征, 周志祥, 等. 低位直肠癌局部切除术后复发因素分析. 中华胃肠外科杂志, 2009, 12(1): 36-39.
27. 林国岳, 邱辉忠, 周皎琳, 等. 经肛门内镜微创手术的适应症与并发症. 中华结直肠疾病电子杂志, 2015, 4(5): 521-525.
28. 邓群, 廖秀军, 杨关根, 等. 经肛手套通路联合结肠镜微创手术治疗直肠肿瘤. 中华胃肠外科杂志, 2014, 17(5): 473-475.

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