Combination instruments: A report on 95 transanal endoscopic microsurgical operations

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Abstract
Summary We report our experience on 95 transanal endoscopic microsurgical (TEM) excisions using a combination instrument. The advantages of the multifunctional electrosurgical device, compared with other conventional techniques, are the following: a very precise bipolar cutting, an effective monopolar coagulation associated with a continuous suction, a rinsing function allowing the identification of bleeding points. These characteristics of the instrument permitted us to perform 88 (92.6%) wide full-thickness excisions and seven (7.4%) mucosectomies of rectal lesions with optimal visualisation of the operative field, lower blood loss and reduced operative time. Fifty-seven sessile adenomas and 38 adenocarcinomas in selected patients were treated by TEM. Preoperative radiotherapy was associated in T2-T3 rectal cancer. In all cases, the intra-operative course was uneventful. There was no mortality. Postoperative pain was minimal; the average hospital stay was 5 days. No major postoperative complications were observed. Minor complications occurred in eight (8.4%) patients; these were resolved with medical treatment. TEM local excision with a combination instrument allowed safe, full-thickness removal of rectal tumours, with a low complication rate and a rapid return to normal activities.

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