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Langenbeck's Archives of Surgery

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02-06-2022 | Minimally Invasive Surgery | Original Article

Transanal endoscopic microsurgical submucosal dissection (TEM-ESD) for rectal adenomas: a retrospective cohort study of 145 consecutive cases

Authors: Konstantinos Kouladouros, Jörg Baral

Published in: Langenbeck's Archives of Surgery | Issue 6/2022

Abstract

Purpose

Transanal endoscopic microsurgery (TEM) and endoscopic submucosal dissection (ESD) are currently the two most popular methods for resecting large rectal adenomas en bloc. However, damage to the mesorectum in the case of TEM, plus the technical challenges and long procedure times of flexible ESD, are major disadvantages of these procedures. Transanal endoscopic microsurgical submucosal dissection (TEM-ESD) is a new technique, combining the ergonomic features of TEM with the minimally invasive approach of ESD. The aim of our study was to assess the feasibility and safety of TEM-ESD for resection of large rectal adenomas.

Methods

We retrospectively analyzed all TEM-ESD procedures performed in Karlsruhe Municipal Hospital between 2012 and 2019, isolated all cases of adenomas, and analyzed the perioperative and follow-up data of the patients.

Results

We identified 145 cases matching our criteria. The median size of the lesions was 4.2 cm, and the median operating time was 45 min. The en bloc resection rate was 100%, and the complete en bloc resection rate was 78.6%. The overall morbidity rate was 6.9%. In a median follow-up period of 24 months, there was a local recurrence in 4.8% of the cases.

Conclusions

TEM-ESD is a safe and feasible therapeutic option for resecting large rectal adenomas, offering high en bloc resection and low recurrence rates combined with short operating time and low morbidity.

Trial Registration Number (ClinicalTrials.gov)

NCT04870931.

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Title: Transanal endoscopic microsurgical submucosal dissection (TEM-ESD) for rectal adenomas: a retrospective cohort study of 145 consecutive cases
Authors: Konstantinos Kouladouros
Jörg Baral
Publication date: 02-06-2022
Publisher: Springer Berlin Heidelberg
Keyword: Minimally Invasive Surgery
Published in: Langenbeck's Archives of Surgery / Issue 6/2022
Print ISSN: 1435-2443
Electronic ISSN: 1435-2451
DOI: https://doi.org/10.1007/s00423-022-02562-0

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Transanal endoscopic microsurgical submucosal dissection (TEM-ESD) for rectal adenomas: a retrospective cohort study of 145 consecutive cases

Abstract

Purpose

Methods

Results

Conclusions

Trial Registration Number (ClinicalTrials.gov)

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Trial Registration Number (ClinicalTrials.gov)

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