LETTERS TO THE EDITOR

 

Transanal submucosal endoscopic resection (TASER) by TEO system^®

Resección endoscópica submucosa transanal (TASER) mediante sistema TEO

 

 

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Key words: Endoscopy. Rectal tumor. Transanal endoscopic surgery.

Palabras clave: Endoscopia. Tumor rectal. Cirugía transanal endoscópica.

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Dear Editor,

We report the case of a 51-year-old male who underwent to colonoscopy due to rectal bleeding. Polypectomy of an 8 mm sessile polyp (grade 0-Is) located 12 cm from the anal verge was performed. Histology, it showed a moderately differentiated intramucosal adenocarcinoma, without lymphovascular or perineural invasion, but reaching the resection margin. In the control endoscopy, the scar from previous polypectomy showed an irregular aspect, with retraction of folds, and using NBI appears like a Nice type III, compatible with infiltration/dysplasia. After extension study, we performed a transanal submucosal endoscopic resection (Fig. 1). The postoperative was uneventful, and the patient was discharged the next day. The surgical specimen showed no malignancy data.

 

 

Discussion

Submucosal resection techniques for digestive tumors have proliferated considerably in recent years, although its spread has been limited by the complex learning curve. Transanal resection techniques are more established, and in some cases have replaced conventional surgical procedures (1). However, as long as resection involves entry into the peritoneal cavity, the risk of leak will be present (2).

A new procedure has been described recently: transanal submucosal endoscopic resection (TASER) (3,4). The reference to the endoscopic component is double, combining the endoscope with endoanal resection devices. The main advantage of this technique is the introduction of the principles of traction-countertraction to the endoscopic field (5), added to the availability of the surgical instrumental for treating complications.

The TEO system^® (Karl Storz- Tuttlingen - Germany) was designed to complete wall resections, but the versatility of its ports allows to perform TASER, with the advantage that its integrated camera provides brightness and an overall picture of the surgical field.

The use of these techniques in medium-high rectum facilitates submucosal resection, improving the learning curve.

 

José Luis Muñoz-de-Nova¹, Francisco Eduardo Viamontes-Ugalde¹
and Jorge Mendoza-Jiménez-Ridruejo^2
1Departments of General Surgery and Digestive Diseases, and ²Digestive Medicine.
Hospital Universitario La Princesa. Madrid, Spain

 

References

1. McLemore EC, Weston LA, Coker AM, et al. Transanal minimally invasive surgery for benign and malignant rectal neoplasia. Am J Surg 2014;208:372-81. DOI: 10.1016/j.amjsurg.2014.01.006.         [ Links ]

2. Molina G, Bordeianou L, Shellito P, et al. Transanal endoscopic resection with peritoneal entry: a word of caution. Surg Endosc 2015 Aug 12 (Epub ahead of print) DOI: 10.1007/s00464-015-4452-y.         [ Links ]

3. Tsiamoulos ZP, Warusavitarne J, Saunders BP. Transanal submucosal endoscopic resection: a new endosurgical approach to the resection of giant rectal lesions. Endoscopy 2014;46:401-2. DOI: 10.1055/s-0034-1377545.         [ Links ]

4. Tsiamoulos ZP, Warusavitarne J, Faiz O, et al. A new instrumental platform for Trans-Anal Submucosal Endoscopic Resection (TASER). Gut 2015;64:1-3. DOI: 10.1136/gutjnl-2015-309643.         [ Links ]

5. Saunders BP, Tsiamoulos ZP, Thomas H, et al. Rectal endoscopic submucosal dissection made easy: A solution to the retraction problem. Gastroenterology 2013;145:939-41. DOI: 10.1053/j.gastro.2013.08.057.         [ Links ]