Minimally Invasive Transanal Surgery for Early Rectal Cancer and Large Adenomas

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• Video-Assisted Transanal Surgery Explained
• Evolution from Rigid to Flexible Technique
• Key Surgical and Patient Advantages
• Ideal Candidates for the Procedure
• Surgical Technique and Resection Details
• Full Transcript

Video-Assisted Transanal Surgery Explained

Video-assisted transanal surgery is a modern minimally invasive technique for treating rectal lesions. Dr. Christoph Maurer, MD, a leading abdominal cancer surgeon, describes it as a significant advance. The procedure involves inserting a flexible single-incision laparoscopic surgery port into the anus. Surgeons then operate using instruments and a camera while viewing a monitor. This method provides a superior angle for dissecting tumors compared to older rigid techniques.

Evolution from Rigid to Flexible Technique

The technique represents a major evolution from earlier methods like transanal endoscopic microsurgery (TEMS). Dr. Christoph Maurer, MD, references the pioneering work of Dr. Gerhard Buess in the 1980s. That original approach used a large, rigid steel tube inserted into the anus. Dr. Christoph Maurer, MD, explains that the rigid tube made instrument angling and tumor extraction difficult. The new flexible port system overcomes these limitations, facilitating a much smoother and more effective surgical dissection for the surgeon.

Key Surgical and Patient Advantages

This minimally invasive approach offers substantial benefits for both surgeons and patients. Dr. Christoph Maurer, MD, highlights the markedly reduced costs associated with the new device. The video-assisted technique provides a wide-angle view and excellent instrument maneuverability. For patients, this translates to a less invasive operation and a faster recovery time. Dr. Anton Titov, MD, notes the importance of this advancement, aligning it with the broader trend of minimally invasive surgery across various specialties.

Ideal Candidates for the Procedure

Video-assisted transanal surgery is not suitable for all rectal cancers. Dr. Christoph Maurer, MD, specifies the types of lesions that are ideal for this approach. The procedure is excellent for removing large, flat rectal adenomas, even those involving almost the entire rectal circumference. It is also a primary treatment option for early rectal cancers. Specifically, this means T1 stage tumors that show no evidence of lymph node metastasis, as confirmed by preoperative staging.

Surgical Technique and Resection Details

The surgical execution involves a precise full-thickness resection of the rectal wall for cancerous tumors. Dr. Christoph Maurer, MD, details that surgeons perform a complete dissection through all layers of the bowel wall. After removing the tumor, the resulting wound is meticulously closed with a running suture. Dr. Anton Titov, MD, emphasizes that surgeon experience is critical for performing this resection without complications. The procedure, also known as Transanal Endoscopic Video-Assisted (TEVA) excision, requires significant expertise to achieve the best outcomes for patients.

Full Transcript

Dr. Anton Titov, MD: Which patients are best candidates for minimally invasive rectal cancer surgery? What is video-assisted transanal surgery (TEVA)? How to choose the right type of treatment for Stage 1 rectal cancer? Leading Swiss abdominal cancer surgeon explains surgical treatment options for colorectal cancer and liver tumors.

Rectal cancer minimally invasive surgery. Dr. Anton Titov, MD. Rectal cancer diagnosis is fortunately made at earlier stages today. Early rectal cancer, precancerous lesions, and benign adenomas are now being treated with minimally invasive surgical techniques.

One such minimally invasive rectal cancer surgery is called transanal endoscopic microsurgery. You're an expert in minimal invasive surgery in coloproctology. You extensively use minimally invasive surgery techniques for colon cancer and rectal cancer treatment.

What are recent advances in minimal invasive surgery for rectal cancer? What minimally invasive methods do you use for other colorectal precancerous lesions?

Dr. Christoph Maurer, MD: Yes, one of the most impressive advances in my hands is a new device for transanal dissections of early rectal cancer. We also use it to resect huge adenomas. You remember that in the 1980s, Dr. Gerhard Buess created a large steel tube. It was inserted in the anus for rectal cancer surgery.

Through this steel tube, Dr. Buess did his resections that were just difficult to accomplish. Within this rigid tube, it was difficult to get angles with your instruments. It was also difficult to remove the rectal tumors.

What we do is we insert a single-incision laparoscopic surgery port within the anus. This is a minimally invasive rectal cancer surgery operation. This is a flexible device in which you can insert your instruments. You can angle with your instruments to resect the rectal cancer tumor.

That facilitates very much the dissection of the rectal cancer tumor. You look in the video when you go into the anus with a camera. You operate on rectal cancer while looking at the monitor. So you have a big advantage.

You can do submucosal dissections. You can even complete rectal wall dissections of invasive rectal cancer. You can perform complete full-thickness rectal wall dissections without any problems. This is minimally invasive transanal surgery. This is really a big advantage.

Also, costs of rectal cancer surgery are markedly reduced with this device.

Dr. Anton Titov, MD: So it is essentially an endoscopic surgery. You get the wider angle of view. You essentially perform a laparoscopic resection of the rectal cancer tumor. This minimally invasive technology is convenient for the surgeon. It also makes better results for the patient. Patients recover faster after surgical operation.

Dr. Christoph Maurer, MD: Absolutely. We call it video-assisted transanal surgery. It's not really laparoscopy because we are not in the abdominal cavity. But we use the same tools. So we call it video-assisted transanal surgery.

Our technique is similar to laparoscopy. And it facilitates minimally invasive resection of rectal cancer tumors. It's really nice, I think. We like this minimally invasive transanal tumor surgery.

Dr. Anton Titov, MD: And what kind of lesions are suitable for such endoscopic surgery?

Dr. Christoph Maurer, MD: The large rectal adenomas, especially the flat, large adenomas. We can even remove the adenomas that have almost the whole circumference of the rectum. All these rectal adenomas are possible to remove with this technique.

We can resect early rectal cancers. That means T1 rectal tumors without evidence of lymph node metastasis. In these tumors, we do a full-thickness rectal wall resection. We close the wound with a running suture.

Dr. Anton Titov, MD: This is an important advantage, and it follows the minimal invasive and video-assisted surgical techniques in other surgery fields. Minimally invasive surgery is widely used in thoracic surgery, in abdominal surgery, and now in colorectal surgery. So that's important for patients to know.

Dr. Christoph Maurer, MD: Yes. Rectal cancer minimally invasive surgery. Video-assisted transanal surgery can be done for early stages of rectal cancer. Transanal Endoscopic Video-Assisted (TEVA) excision of rectal cancer tumor is the best surgery method.

Your surgeon must have a lot of experience with video-assisted transanal surgery to perform rectal cancer resection without complications. Why transanal surgery is the best minimally invasive rectal cancer treatment? Transanal Endoscopic Microsurgery (TEMS) is another method to treat rectal cancer.