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Surgical Endoscopy
Published in: Surgical Endoscopy 12/2012

01-12-2012

Transanal endoscopic video-assisted (TEVA) excision

Authors: Madhu Ragupathi, Dominique Vande Maele, Javier Nieto, T. Bartley Pickron, Eric M. Haas

Published in: Surgical Endoscopy | Issue 12/2012

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Abstract

Background

Transanal endoscopic video-assisted (TEVA) excision represents an alternative approach for the surgical treatment of middle and upper rectal lesions not amenable to colonoscopic removal. Utilizing principles of single-incision laparoscopic surgery, this novel minimally invasive approach optimizes access for safe and complete removal of these lesions without the need for a formal rectal resection. We describe our technique and early outcomes with TEVA excision.

Methods

Between March 2010 and September 2011, TEVA excision was performed for patients presenting for management of rectal lesions not amenable to colonoscopic or standard transanal removal. Patients were selected if they presented with benign disease or superficial adenocarcinoma, and the proximal extent of the lesion extended beyond 8 cm from the anal verge. Demographic, intraoperative, and postoperative data were assessed. A SILS™ port was placed in the anal canal for access in all cases. Standard laparoscopic instruments were utilized for visualization, full-thickness transanal excision, and primary closure.

Results

Twenty patients (50 % male) with a mean age of 64.6 ± 10.9 years, mean body mass index of 28.2 ± 4.9 kg/m2, and median American Society of Anesthesiologist score of 2 underwent TEVA excision. Fourteen patients (70 %) presented with benign disease and six patients (30 %) presented with malignant disease. The mean size of the lesions was 3.0 ± 1.4 cm, and the mean distance from the anal verge was 10.6 ± 2.4 cm. All excisions were successfully completed with a mean operative time of 79.8 ± 25.1 (range, 45–135) min. The mean length of hospital stay was 1.1 ± 0.7 (range, 0-3) days.

Conclusions

TEVA excision is a safe and feasible approach for local excision of rectal lesions not otherwise amenable to standard techniques. Continued investigation and development will be important to establish its role in minimally invasive colorectal surgery.
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Metadata
Title
Transanal endoscopic video-assisted (TEVA) excision
Authors
Madhu Ragupathi
Dominique Vande Maele
Javier Nieto
T. Bartley Pickron
Eric M. Haas
Publication date
01-12-2012
Publisher
Springer-Verlag
Published in
Surgical Endoscopy / Issue 12/2012
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-012-2399-9

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