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May 1, 2014, 12:16:36 PM5/1/14

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Ricardo Belda Lozano

MD,PhD, MS.

Master en Cirugía Laparoscópica

Master en Coloproctología

http://coloprocto.wordpress.com/

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Asunto: What's new for ' Actualizaci??n TEM' in PubMed
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Sender's message: Nueva Bibliografía del TEM
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Search: "Rectum"[Mesh] OR "Rectal Neoplasms"[Mesh] AND "Microsurgery"[Mesh]

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PubMed Results
Items 1 - 4 of 4

1. Dis Colon Rectum. 2014 Apr;57(4):549-52. doi: 10.1097/DCR.0000000000000104.
Transanal endoscopic microsurgery colorectal anastomosis: a critical step to natural orifice colorectal surgery in humans.
Hall DJ¹, Farmer KC, Roth HS, Warrier SK.
Author information:
¹1Colorectal Surgical Unit, Alfred Health, Melbourne, Victoria, Australia 2Division of Cancer Surgery, Peter MacCallum Cancer Institute, Melbourne, Victoria, Australia.
Abstract
BACKGROUND:
Transanal endoscopic microsurgery is used in the surgical management of advanced rectal polyps and early rectal cancers. There are case reports of transanal endoscopic microsurgery colorectal anastomoses being performed with laparoscopic assistance in humans.
METHODS:
The concept of a transanal endoscopic microsurgery colorectal anastomosis without laparoscopic assistance has been discussed and trialed on animal and cadaveric specimens; however, to date, there have been no technical reports of this particular procedure in the literature.
RESULTS:
We present a technical note describing a transanal endoscopic microsurgery intraperitoneal colorectal anastomosis in a live human without laparoscopic assistance.
PMID: 24608316 [PubMed - indexed for MEDLINE]
Related citations

2. Dis Colon Rectum. 2014 Apr;57(4):438-41. doi: 10.1097/DCR.0000000000000063.
Outcomes after transanal endoscopic microsurgery with intraperitoneal anastomosis.
Eyvazzadeh DJ¹, Lee JT, Madoff RD, Mellgren AF, Finne CO.
Author information:
¹1Colon and Rectal Surgery, Department of Surgery, St. Luke's University Health Network, Bethlehem, Pennsylvania 2Division of Colon and Rectal Surgery, Department of Surgery, University of Minnesota School of Medicine, Minneapolis, Minnesota 3Division of Colon and Rectal Surgery, University of Illinois at Chicago, Chicago, Illinois.
Abstract
BACKGROUND:
Transanal endoscopic microsurgery has gained increasing popularity as a treatment alternative for early stage rectal neoplasms. With continued advances in technique and experience, more proximal rectal tumors are being surgically managed by using transanal endoscopic microsurgery with an intraperitoneal anastomosis.

OBJECTIVE:
The purpose of this study was to review the outcomes of patients who have undergone intraperitoneal anastomosis with the use of the transanal endoscopic microsurgery technique.
DESIGN:
A prospective, single-surgeon database documented 445 consecutive patients undergoing transanal endoscopic microsurgery from October 1, 1996 through January 1, 2012. We retrospectively reviewed information from all patients who underwent transanal endoscopic microsurgery with an intraperitoneal anastomosis in this prospective database.
SETTINGS:
All procedures took place in an inpatient hospital setting.
PATIENTS:
All patients satisfied workup criteria to undergo surgery for rectal neoplasm.
INTERVENTIONS:
All patients underwent transanal endoscopic microsurgery for rectal neoplasm.
MAIN OUTCOME MEASURES:
Size and pathology of lesion, length of procedure, hospital stay, estimated blood loss, margin status, and complications were the outcomes measured.
RESULTS:
Twenty-eight patients who underwent transanal endoscopic microsurgery had definitively documented intraperitoneal entry and anastomosis. Median follow-up was 12 months (range, 0.5-111 months). There were no operative mortalities. Procedure-related complications included urinary retention (11%), fever (11%), and fecal seepage (4%). Four patients (14%) had positive margins on final pathology. One patient (3%) required abdominal exploration for an anastomotic leak but did not require diversion.
LIMITATIONS:
Although this study analyzes prospectively collected data, it is nonetheless a retrospective analysis that can introduce bias. Because this is a single-center study with a relatively homogenous population, the results may not be generalizable. Our sample size may also be underpowered to detect clinically significant outcomes.
CONCLUSIONS:
Transanal endoscopic microsurgery with intraperitoneal anastomosis can be safely performed without fecal diversion by experienced surgeons.
PMID: 24608299 [PubMed - indexed for MEDLINE]
Related citations

3. Best Pract Res Clin Gastroenterol. 2014 Feb;28(1):143-57. doi: 10.1016/j.bpg.2013.11.005. Epub 2013 Dec 4.
Transanal endoscopic microsurgery.
Smart CJ¹, Cunningham C², Bach SP³.
Author information:
¹School of Cancer Studies, Academic Department of Surgery, Room 28, 4th Floor,Queen Elizabeth Hospital Edgbaston, Birmingham B15 2TH, UK. Electronic address: christop...@nhs.net.
²Oxford University Hospitals NHS Trust, John Radcliffe Hospital, Headley Way, Headington, England OX3 9DU, UK. Electronic address: chriscu...@nhs.net.
³School of Cancer Studies, Academic Department of Surgery, Room 28, 4th Floor,Queen Elizabeth Hospital Edgbaston, Birmingham B15 2TH, UK. Electronic address: s.p....@bham.ac.uk.
Abstract
Transanal endoscopic microsurgery (TEMS) is a well established method of accurate resection of specimens from the rectum under binocular vision. This review examines its role in the treatment of benign conditions of the rectum and the evidence to support its use and compliment existing endoscopic treatments. The evolution of TEMS in early rectal cancer and the concepts and outcomes of how it has been utilised to treat patients so far are presented. The bespoke nature of early rectal cancer treatment is changing the standard algorithms of rectal cancer care. The future of TEMS in the organ preserving treatment of early rectal cancer is discussed and how as clinicians we are able to select the correct patients for neoadjuvant or radical treatments accurately. The role of radiotherapy and outcomes from combination treatment using TEMS are presented with suggestions for areas of future research.
Copyright © 2014. Published by Elsevier Ltd.
PMID: 24485262 [PubMed - indexed for MEDLINE]
Related citations

4. Surg Endosc. 2013 Sep;27(9):3315-21. doi: 10.1007/s00464-013-2911-x. Epub 2013 Mar 12.
Previous transanal endoscopic microsurgery for rectal cancer represents a risk factor for an increased abdominoperineal resection rate.
Morino M¹, Allaix ME, Arolfo S, Arezzo A.
Author information:
¹Digestive, Colorectal, Oncologic, and Minimally Invasive Surgery, Department of Surgical Sciences, University of Torino, Corso A M Dogliotti 14, 10126 Torino, Italy. mario....@unito.it
Abstract
BACKGROUND:
Transanal endoscopic microsurgery (TEM) represents a surgical option in the treatment of selected early rectal cancers. However, when definitive histopathology shows negative prognostic factors, rectal resection with total mesorectal excision (TME) is recommended to reduce the risk of recurrence. No studies have yet analyzed the impact of previous TEM on the perioperative outcomes of immediate laparoscopic TME (LTME) for rectal cancer. The aim of this study was to evaluate the perioperative outcomes of LTME after TEM for rectal cancer.
METHODS:
This study was a retrospective analysis of a prospective database. All patients undergoing LTME within 8 weeks after full-thickness TEM for rectal cancer between January 2001 and December 2011 were included. Each patient was matched on the basis of demographic and clinical characteristics with two patients undergoing primary LTME for rectal cancer during the same period. Age, gender, body mass index, tumor distance from the anal verge, tumor size, neoadjuvant chemoradiation, previous TEM, rectal wall defect size created during TEM, and intraoperative complications were included in a multivariate analysis to identify risk factors for abdominoperineal resection (APR).
RESULTS:
A total of 17 patients undergoing TEM followed by LTME were compared to 34 patients undergoing primary LTME. Mean operative time of LTME after TEM was significantly higher (206 vs. 188 min, P = 0.025). APR was more frequently performed after TEM [odds ratio (OR) 5.25, P = 0.028] and in male patients (OR 9.04, P = 0.034). On multivariate analysis, a previous TEM was the only independent predictor of APR (OR 4.13, P = 0.046). The incidence and severity of postoperative complications were similar in both groups. Mesorectum integrity was complete in all cases.
CONCLUSIONS:
LTME after TEM is a challenging procedure, with a significantly higher risk of APR compared to primary LTME. Future improvements in preoperative patient selection for TEM are needed to reduce this risk.
PMID: 23479257 [PubMed - indexed for MEDLINE]
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1.	Dis Colon Rectum. 2014 Apr;57(4):549-52. doi: 10.1097/DCR.0000000000000104. Transanal endoscopic microsurgery colorectal anastomosis: a critical step to natural orifice colorectal surgery in humans. Hall DJ¹, Farmer KC, Roth HS, Warrier SK. Author information: ¹1Colorectal Surgical Unit, Alfred Health, Melbourne, Victoria, Australia 2Division of Cancer Surgery, Peter MacCallum Cancer Institute, Melbourne, Victoria, Australia. Abstract BACKGROUND: Transanal endoscopic microsurgery is used in the surgical management of advanced rectal polyps and early rectal cancers. There are case reports of transanal endoscopic microsurgery colorectal anastomoses being performed with laparoscopic assistance in humans. METHODS: The concept of a transanal endoscopic microsurgery colorectal anastomosis without laparoscopic assistance has been discussed and trialed on animal and cadaveric specimens; however, to date, there have been no technical reports of this particular procedure in the literature. RESULTS: We present a technical note describing a transanal endoscopic microsurgery intraperitoneal colorectal anastomosis in a live human without laparoscopic assistance.
	PMID: 24608316 [PubMed - indexed for MEDLINE]
	Related citations

2.	Dis Colon Rectum. 2014 Apr;57(4):438-41. doi: 10.1097/DCR.0000000000000063. Outcomes after transanal endoscopic microsurgery with intraperitoneal anastomosis. Eyvazzadeh DJ¹, Lee JT, Madoff RD, Mellgren AF, Finne CO. Author information: ¹1Colon and Rectal Surgery, Department of Surgery, St. Luke's University Health Network, Bethlehem, Pennsylvania 2Division of Colon and Rectal Surgery, Department of Surgery, University of Minnesota School of Medicine, Minneapolis, Minnesota 3Division of Colon and Rectal Surgery, University of Illinois at Chicago, Chicago, Illinois. Abstract BACKGROUND: Transanal endoscopic microsurgery has gained increasing popularity as a treatment alternative for early stage rectal neoplasms. With continued advances in technique and experience, more proximal rectal tumors are being surgically managed by using transanal endoscopic microsurgery with an intraperitoneal anastomosis. OBJECTIVE: The purpose of this study was to review the outcomes of patients who have undergone intraperitoneal anastomosis with the use of the transanal endoscopic microsurgery technique. DESIGN: A prospective, single-surgeon database documented 445 consecutive patients undergoing transanal endoscopic microsurgery from October 1, 1996 through January 1, 2012. We retrospectively reviewed information from all patients who underwent transanal endoscopic microsurgery with an intraperitoneal anastomosis in this prospective database. SETTINGS: All procedures took place in an inpatient hospital setting. PATIENTS: All patients satisfied workup criteria to undergo surgery for rectal neoplasm. INTERVENTIONS: All patients underwent transanal endoscopic microsurgery for rectal neoplasm. MAIN OUTCOME MEASURES: Size and pathology of lesion, length of procedure, hospital stay, estimated blood loss, margin status, and complications were the outcomes measured. RESULTS: Twenty-eight patients who underwent transanal endoscopic microsurgery had definitively documented intraperitoneal entry and anastomosis. Median follow-up was 12 months (range, 0.5-111 months). There were no operative mortalities. Procedure-related complications included urinary retention (11%), fever (11%), and fecal seepage (4%). Four patients (14%) had positive margins on final pathology. One patient (3%) required abdominal exploration for an anastomotic leak but did not require diversion. LIMITATIONS: Although this study analyzes prospectively collected data, it is nonetheless a retrospective analysis that can introduce bias. Because this is a single-center study with a relatively homogenous population, the results may not be generalizable. Our sample size may also be underpowered to detect clinically significant outcomes. CONCLUSIONS: Transanal endoscopic microsurgery with intraperitoneal anastomosis can be safely performed without fecal diversion by experienced surgeons.
	PMID: 24608299 [PubMed - indexed for MEDLINE]
	Related citations

3.	Best Pract Res Clin Gastroenterol. 2014 Feb;28(1):143-57. doi: 10.1016/j.bpg.2013.11.005. Epub 2013 Dec 4. Transanal endoscopic microsurgery. Smart CJ¹, Cunningham C², Bach SP³. Author information: ¹School of Cancer Studies, Academic Department of Surgery, Room 28, 4th Floor,Queen Elizabeth Hospital Edgbaston, Birmingham B15 2TH, UK. Electronic address: christop...@nhs.net. ²Oxford University Hospitals NHS Trust, John Radcliffe Hospital, Headley Way, Headington, England OX3 9DU, UK. Electronic address: chriscu...@nhs.net. ³School of Cancer Studies, Academic Department of Surgery, Room 28, 4th Floor,Queen Elizabeth Hospital Edgbaston, Birmingham B15 2TH, UK. Electronic address: s.p....@bham.ac.uk. Abstract Transanal endoscopic microsurgery (TEMS) is a well established method of accurate resection of specimens from the rectum under binocular vision. This review examines its role in the treatment of benign conditions of the rectum and the evidence to support its use and compliment existing endoscopic treatments. The evolution of TEMS in early rectal cancer and the concepts and outcomes of how it has been utilised to treat patients so far are presented. The bespoke nature of early rectal cancer treatment is changing the standard algorithms of rectal cancer care. The future of TEMS in the organ preserving treatment of early rectal cancer is discussed and how as clinicians we are able to select the correct patients for neoadjuvant or radical treatments accurately. The role of radiotherapy and outcomes from combination treatment using TEMS are presented with suggestions for areas of future research. Copyright © 2014. Published by Elsevier Ltd.
	PMID: 24485262 [PubMed - indexed for MEDLINE]
	Related citations

4.	Surg Endosc. 2013 Sep;27(9):3315-21. doi: 10.1007/s00464-013-2911-x. Epub 2013 Mar 12. Previous transanal endoscopic microsurgery for rectal cancer represents a risk factor for an increased abdominoperineal resection rate. Morino M¹, Allaix ME, Arolfo S, Arezzo A. Author information: ¹Digestive, Colorectal, Oncologic, and Minimally Invasive Surgery, Department of Surgical Sciences, University of Torino, Corso A M Dogliotti 14, 10126 Torino, Italy. mario....@unito.it Abstract BACKGROUND: Transanal endoscopic microsurgery (TEM) represents a surgical option in the treatment of selected early rectal cancers. However, when definitive histopathology shows negative prognostic factors, rectal resection with total mesorectal excision (TME) is recommended to reduce the risk of recurrence. No studies have yet analyzed the impact of previous TEM on the perioperative outcomes of immediate laparoscopic TME (LTME) for rectal cancer. The aim of this study was to evaluate the perioperative outcomes of LTME after TEM for rectal cancer. METHODS: This study was a retrospective analysis of a prospective database. All patients undergoing LTME within 8 weeks after full-thickness TEM for rectal cancer between January 2001 and December 2011 were included. Each patient was matched on the basis of demographic and clinical characteristics with two patients undergoing primary LTME for rectal cancer during the same period. Age, gender, body mass index, tumor distance from the anal verge, tumor size, neoadjuvant chemoradiation, previous TEM, rectal wall defect size created during TEM, and intraoperative complications were included in a multivariate analysis to identify risk factors for abdominoperineal resection (APR). RESULTS: A total of 17 patients undergoing TEM followed by LTME were compared to 34 patients undergoing primary LTME. Mean operative time of LTME after TEM was significantly higher (206 vs. 188 min, P = 0.025). APR was more frequently performed after TEM [odds ratio (OR) 5.25, P = 0.028] and in male patients (OR 9.04, P = 0.034). On multivariate analysis, a previous TEM was the only independent predictor of APR (OR 4.13, P = 0.046). The incidence and severity of postoperative complications were similar in both groups. Mesorectum integrity was complete in all cases. CONCLUSIONS: LTME after TEM is a challenging procedure, with a significantly higher risk of APR compared to primary LTME. Future improvements in preoperative patient selection for TEM are needed to reduce this risk.
	PMID: 23479257 [PubMed - indexed for MEDLINE]
	Related citations