0000000000287268
AUTHOR
Gerhard F. Buess
Clinical results of transanal endoscopic microsurgery
Using the "transanal endoscopic microsurgery" technique, 140 patients were treated at the Department of Surgery in Cologne and Mainz. Of the patients with adenomas, 68.2% had typical symptoms preoperatively. The postoperative hospital attendance was 8.7 days, with an average resection size of 14.4 cm2. The postoperative complication rate was 5%, and there were no deaths related to the technique. In a prospective controlled trial, 2.2% of the patients with adenomas treated endoscopically in Mainz showed recidivation, requiring reoperation. The follow-up rate was 100%. In 30 cases, microscopic examination revealed carcinoma. Radical reoperation in 8 pT1 tumours showed neither remaining tumour…
Endoscopic microsurgical dissection of the esophagus. Results in an animal model.
Blunt dissection of the esophagus is considered the least invasive technique in the treatment of either benign or malignant diseases of the esophagus. Its disadvantage is that it has to be carried out blindly. The results may be uncontrollable hemorrhage, unrecognized injuries to the trachea, and damage to the recurrent laryngeal nerve. In order to reduce the degree of invasiveness a new endoscopic microsurgical technique for the dissection of the esophagus has been developed and tried out in animals. This paper presents the operative technique. Our new endoscopic microsurgical technique obviates a thoracotomy, while direct endoscopic vision results in improved dissection. The magnified end…
Endoscopic Microsurgery of Rectal Tumors
Seventy-five patients with sessile adenomas or early carcinomas of the rectum or rectosigmoid were operated on with the new technique "transanal endoscopic microsurgery" Employing a newly developed complex endoscopic operating system, complete removal of sessile adenomas can be accomplished up to a distance of 25 cm from the anal verge, accurately and non-invasively. Complications occurred in three cases, with no resulting mortality. In the follow-up period we discovered only one adenomatous recurrence that required operative treatment. The superior accuracy of preparation, a short average stay in hospital, and low recurrence and complication rates are the advantages of this transanal endos…
Das prim�re mediastinale Seminom
Die seltenen primaren extragonadalen Seminome sind mit in die Differentialdiagnose des unklaren Mediastinaltumors einzubeziehen. Die Symptomatik ist uncharakteristisch, die Diagnose wird in den meisten Fallen durch eine Thoracotomie bzw. Sternotomie gestellt. Therapeutisch steht das chirurgische Vorgehen mit kurativer Zielsetzung oder palliativer Tumorverkleinerung im Vordergrund. Bei makroskopisch vollstandig entferntem Tumor ist die Nachbestrahlung des Mediastinums zu diskutieren, bei metastasierendem Tumor sollte postoperativ eine Chemotherapie mit Cisplatin enthaltenden Kombinationen durchgefuhrt werden.
Technique of transanal endoscopic microsurgery.
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 retror…
Endoluminal sonography in follow-up of rectal carcinoma.
Fourteen patients who had undergone local excision, anterior resection or low anterior resection for rectal carcinoma were examined by endoscopic ultrasonography. In two of three cases of local recurrent carcinomas, endoscopic sonography was superior to computed tomography in determining the depth of tumor infiltration. There were difficulties in differentiating scar tissue from local tumor formation when the mucosa appeared normal upon endoscopic examination. Only repeated follow-up examinations starting in the postoperative period, will allow a differentiation between scar tissue and local tumor recurrence.
Endoluminal ultrasonic examination of sessile polyps and early carcinomas of the rectum
The results of conventional endosonographic techniques in the assessment of early carcinomas and sessile polyps of the rectum have been unsatisfactory. We therefore developed a new technique in which the rectal cavity is filled directly with water. Using this technique, the anatomy of small rectal tumors is preserved and the layers of the rectal wall are easier to differentiate, especially with a 10-MHz scanner. The clinical results in 66 patients demonstrate that this new technique is very accurate in the preoperative staging of adenomas and T1-carcinomas of the rectum.
Training program for transanal endoscopic microsurgery.
Televised endoscopy and the concept of the “assisted” endoscopic operation is of great help in teaching surgical endoscopic techniques. The use of training dummies provides a new method of training manual dexterity and surgical skills in special courses or in surgical skill laboratories. We have developed a training system for transanal endoscopic microsurgery. Operations with our technique were performed on 116 patients. Like other microsurgical techniques, our method requires a special introduction and intensive training. This paper presents our multistage, video-supported training course for teaching transanal endoscopic microsurgery. The one-day training session is divided into four ste…
Der Aussagewert der endorektalen Sonographie beim präoperativen Tumorstaging und der postoperativen Tumornachsorge
Fortgeschrittene Rektumkarzinome werden kontinenzerhaltend reseziert bzw. abdominoperineal exstirpiert. Fruhe Stadien des Rektumkarzinoms konnen dagegen moghcherweise durch die lokale Exzision als ausreichend therapiert angesehen werden. Entscheidend fur die Selektion der Patienten zur lokalen Exzision ist eine moghchst exakte praoperative Beurteilung der Tumorinfiltration. Die Treffsicherheit der rektal-digitalen Untersuchung bei der Beurteilung fruher Stadien des Rektumkarzinoms hegt bei etwa nur 70% [4]. Die Endosonographie eroffnet hier neue Moglichkeiten. Wie verschiedene Autoren zeigen konnten, ist endosonographisch eine zuverlassige Beurteilung des T-Stadiums in knapp 90% der Falle m…
Die endoskopische Durchtrennung der Perforansvenen
Bei der Entstehung chronisch venoser Insuffizienzen sind Perforansvenen bedeutsam. Die endoskopische Technik nach G. Hauer erlaubt eine Durchtrennung insuffizienter Perforansvenen unter direkter Sicht, bei geringem Operationstrauma. An der Chirurgischen Klinik Mainz wurden 22 Patienten (20 Patienten in Kombination mit Varizenexhairese) endoskopisch operiert. Erste postoperative Nachuntersuchungsergebnisse zeigen befriedigende Ergebnisse bei 16 Patienten. Chronisch venose Insuffizienzen wurden mit 2 Ausnahmen verbessert oder vollig abgeheilt.
Endorektale Sonographie zur präoperativen Beurteilung der Infiltrationstiefe von Rektumtumoren
From June 1987 to February 1990, 142 out of 319 patients with rectal tumours were investigated by ultrasound scanning with the object of ascertaining the depth to which the tumour had infiltrated. This examination proved completely feasible in 130 of these patients (84 men, 46 women, mean age 61.7 [42-84] years). Postoperative histological examination revealed an adenoma (n = 59) or a T1 carcinoma (n = 19), while intrarectal ultrasonography disclosed the same findings in 79 patients (true-positive in 75 cases). A T2-tumour was diagnosed by histological examination in 24 patients, and by ultrasonography in 22 (true-positive in 18 cases). The histological diagnosis of a tumour in stage T3 or …