Summary
Sessile adenomas are predominantly localized in the rectum and lower sigma. Surgical removal is indicated but often implies an invasive surgical procedure. Using conventional transanal surgical techniques, only the lower rectum can be reached and there are high rates of recurrence. The new technique combines an endoscopic view of the rectum under gas insufflation via a stereoscopic telescope with conventional surgical preparation and suturing. Adenomas can be excised using the mucosectomy technique or full-thickness-excision, whereas carcinomas should be excised using full-thickness excision with a sufficient border of healthy mucosa. In carcinomas of the sacral cavity, we remove the retrorectal fat up to the fascia of Waldeyer, including the regional lymph nodes. Transanal endoscopic microsurgery is the most economical and tissue-saving surgical technique for the removal of rectal adenomas and early rectal carcinomas.
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References
Allgöwer M, Dürig M, Hochstetter A von, Huber A (1982) The parasacral sphincter-splitting approach to the rectum. World J Surg 6: 539–548
Bühler H, Nüesch HJ, Kobler E, Deyhle P (1979) Der große Kolonpolyp — endoskopische oder chirurgische Entfernung? Dtsch Med Wochenschr 109: 619–620
Buess G, Theiß R, Günther M, Hutterer F, Hepp M, Pichlmaier H (1984) Endoskopische Operationen zur Polypabtragung im Rektum. Colo-proctology 5: 254–261
Häring R, Karavias T, Konradt J (1978) Die posteriore Proktorectotomie. Chirurg 49: 265–271
Hermanek P, Gall FP (1986) Early (microinvasive) colorectal carcinoma. Int J Colorect Dis 1: 79
Kraske P (1885) Zur Exstirpation hochsitzender Mastdarmkrebse. Verh Dtsch Ges Chir 14: 464–474
Mason AY (1970) Surgical access to the rectum — a transphincteric exposure. Proc R Soc Med 63: 91–94
Mason AY (1974) Transsphincteric surgery of the rectum. (Progress in Surgery, vol 13) Karger, Basel, pp 66–97
Morson BC (1966) Factors influencing the prognosis of early cancer of the rectum. Proc R Soc Med 59: 607–608
Morson BC, Sobin LH (1976) Histological typing of intestinal tumors. (WHO International histological classification of tumors, vol 15) WHO, Geneva, p 56
Parks AG (1968) A technique for excising extensive villous papillomatous change in the lower rectum. Proc R Soc Med 61: 441–442
Schiessel R, Wunderlich M, Kerner-Hanusch J (1986) Transanale Excision und Anastomosentechnik. Chirurg 57: 773–778
Schildberg FW, Wenk H (1986) Der posteriore Zugang zum Rectum. Chirurg 57: 779–791
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Buess, G., Kipfmüller, K., Hack, D. et al. Technique of transanal endoscopic microsurgery. Surg Endosc 2, 71–75 (1988). https://doi.org/10.1007/BF00704356
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DOI: https://doi.org/10.1007/BF00704356