Abstract
Background
For transanal endoscopic microsurgery, the ultracision Harmonic Scalpel (UC) and the multifunctional TEM400 instrument (T400) seem advantageous. This study investigated their clinical use.
Methods
Prospective analysis of tumor, patient, and operation characteristics was performed for 196 tumor resections per instrument intended for application.
Results
The T400 instrument was applied in 162 operations, and the UC in 34 operations. Tumor and patient characteristics were similar except for tumor area (respectively, 7.5 and 17 cm2; p = 0.003). Operative time was proportionate to the tumor area (p < 0.001) and inversely proportionate to its distance from the dentate line to the lower margin of the tumor of the UC (p = 0.002). Application reduced operative time by 26% (p = 0.02, corrected for area). Whereas, T400 was always singly sufficient for excision, the UC required T400 application in 50% of operations, especially for larger tumors (p = 0.026), with the result that more rectal wall circumference was captured (p = 0.043). Both groups had similar safety parameters.
Conclusions
The UC substantially reduced operative time compared with the T400, but frequently required the T400 for procedure completion. The T400 is always singly sufficient.
Similar content being viewed by others
References
JF Amaral (1995) ArticleTitleLaparoscopic cholecystectomy in 200 consecutive patients using an ultrasonically activated scalpel Surg Laparosc Endosc 5 255–262 Occurrence Handle1:STN:280:DyaK28%2FlvVSgtw%3D%3D Occurrence Handle10.1089/lps.1995.5.255 Occurrence Handle7551275
DN Armstrong WL Ambroze ME Schertzer GR Orangio (2001) ArticleTitleHarmonic Scalpel vs electrocautery hemorrhoidectomy: a prospective evaluation Dis Colon Rectum 44 558–564 Occurrence Handle1:STN:280:DC%2BD3M3jvVGguw%3D%3D Occurrence Handle10.1007/BF02234329 Occurrence Handle11330583
R Berguer DL Forkey WD Smith (1999) ArticleTitleErgonomic problems associated with laparoscopic surgery Surg Endosc 13 466–468 Occurrence Handle1:STN:280:DyaK1M3ksVOnug%3D%3D Occurrence Handle10.1007/PL00009635 Occurrence Handle10227943
R Berguer GT Rab H Abu-Ghaida A Alarcon J Chung (1997) ArticleTitleA comparison of surgeons’ posture during laparoscopic and open surgical procedures Surg Endosc 11 139–142 Occurrence Handle1:STN:280:DyaK2s3it1GjsA%3D%3D Occurrence Handle10.1007/s004649900316 Occurrence Handle9069145
G Buess (1993) ArticleTitleReview: transanal endoscopic microsurgery (TEM) J R Coll Surg Edinb 38 239–245 Occurrence Handle1:STN:280:DyaK2c%2Fks1Onsg%3D%3D Occurrence Handle7693935
G Buess R Theiss F Hutterer H Pichlmaier P Pelz Holfeld Th S Said W Isselhard (1983) ArticleTitleDie transanale endoscopische Rektumoperation: Erprobung einer neuen Methode im Tierversuch Leber Magen Darm 13 73–77 Occurrence Handle1:STN:280:DyaL2c%2FhtlSmtQ%3D%3D Occurrence Handle6621245
C Cocilovo LE Smith T Stahl J Douglas (2003) ArticleTitleTransanal endoscopic excision of rectal adenomas Surg Endosc 17 1461–1463 Occurrence Handle1:STN:280:DC%2BD2c7ks1OhtA%3D%3D Occurrence Handle10.1007/s00464-002-8929-0 Occurrence Handle12739115
T Defechereux F Rinken S Maweja E Hamoir M Meurisse (2003) ArticleTitleEvaluation of the ultrasonic dissector in thyroid surgery: a prospective randomised study Acta Chir Belg 103 274–277 Occurrence Handle10.1080/00015458.2003.11679422 Occurrence Handle12914361
EJ Graaf ParticleDe PG Doornebosch LP Stassen JM Debets GW Tetteroo WC Hop (2002) ArticleTitleTransanal endoscopic microsurgery for rectal cancer Eur J Cancer 38 904–910 Occurrence Handle10.1016/S0959-8049(02)00050-3 Occurrence Handle11978515
KT Boer ParticleDen IH Straatsburg AV Schellinger LT Wit Particlede J Dankelman DJ Gouma (1999) ArticleTitleQuantitative analysis of the functionality and efficiency of three surgical dissection techniques: a time-motion analysis J Laparoendosc Adv Surg Tech A 9 389–395 Occurrence Handle10.1089/lap.1999.9.389
G Farin (1993) ArticleTitlePneumatically controlled bipolar cutting instrument Endosc Surg Allied Technol 1 97–101 Occurrence Handle1:STN:280:DyaK2czjt1Khtw%3D%3D Occurrence Handle8055308
D Gossot G Buess A Cuschieri E Leporte M Lirici R Marvik D Meijer A Melzer MO Schurr (1999) ArticleTitleUltrasonic dissection for endoscopic surgery. The E.A.E.S. Technology Group Surg Endosc 13 412–417 Occurrence Handle1:STN:280:DyaK1M7psVyqsg%3D%3D Occurrence Handle10.1007/s004649901002 Occurrence Handle10094760
A Heintz M Morschel T Junginger (1998) ArticleTitleComparison of results after transanal endoscopic microsurgery and radical resection for Tl carcinoma of the rectum Surg Endosc 12 1145–1148 Occurrence Handle1:STN:280:DyaK1czosVClsQ%3D%3D Occurrence Handle10.1007/s004649900802 Occurrence Handle9716769
CG Huscher MM Lirici M Di Paola F Crafa C Napolitano A Mereu A Recher A Corradi M Amini (2003) ArticleTitleLaparoscopic cholecystectomy by ultrasonic dissection without cystic duct and artery ligature Surg Endosc 17 442–451 Occurrence Handle1:STN:280:DC%2BD3s7gs1ejtw%3D%3D Occurrence Handle10.1007/s00464-002-9068-3 Occurrence Handle12399846
IM Janssen DJ Swank O Boonstra BC Knipscheer JH Klinkenbijl H Goor Particlevan (2003) ArticleTitleRandomized clinical trial of ultrasonic versus electrocautery dissection of the gallbladder in laparoscopic cholecystectomy Br J Surg 90 799–803 Occurrence Handle1:STN:280:DC%2BD3szitlGrsA%3D%3D Occurrence Handle10.1002/bjs.4128 Occurrence Handle12854103
E Kanehira H Raestrup MO Schurr M Wehrmann K Manncke GF Buess (1993) ArticleTitleTransanal endoscopic microsurgery using a newly designed multifunctional bipolar cutting and monopolar coagulating instrument Endosc Surg Allied Technol 1 102–106 Occurrence Handle1:STN:280:DyaK2czjt1Kitg%3D%3D Occurrence Handle8055297
JJ Koesveld GW Tetteroo EJ Graaf (2003) ArticleTitleUse of head-mounted display in transanal endoscopic microsurgery Surg Endosc 17 943–946 Occurrence Handle10.1007/s00464-002-9067-4 Occurrence Handle12632129
C Langer T Liersch M Suss A Siemer P Markus BM Ghadimi L Fuzesi H Becker (2003) ArticleTitleSurgical cure for early rectal carcinoma and large adenoma: transanal endoscopic microsurgery (using ultrasound or electrosurgery) compared to conventional local and radical resection Int J Colorectal Dis 18 222–229 Occurrence Handle1:STN:280:DC%2BD3s7lslWmtA%3D%3D Occurrence Handle12673487
C Langer P Markus T Liersch L Fuzesi H Becker (2001) ArticleTitleUltraCision or high-frequency knife in transanal endoscopic microsurgery (TEM)? Advantages of a new procedure Surg Endosc 15 513–517 Occurrence Handle1:STN:280:DC%2BD3MzjtVCrsA%3D%3D Occurrence Handle10.1007/s004640090015 Occurrence Handle11353972
D Lev-Chelouche D Margel G Goldman MJ Rabau (2000) ArticleTitleTransanal endoscopic microsurgery: experience with 75 rectal neoplasms Dis Colon Rectum 43 662–667 Occurrence Handle1:STN:280:DC%2BD3c3osVKlsw%3D%3D Occurrence Handle10.1007/BF02235583 Occurrence Handle10826428
E Lezoche M Guerrieri A Paganini F Feliciotti F Di Pietrantonj (1996) ArticleTitleIs transanal endoscopic microsurgery (TEM) a valid treatment for rectal tumors? Surg Endosc 10 736–741 Occurrence Handle1:STN:280:DyaK283otFKjsA%3D%3D Occurrence Handle10.1007/BF00193047 Occurrence Handle8662430
MM Lirici M Paola C Ponzano CG Huscher (2003) ArticleTitleCombining ultrasonic dissection and the Storz operation rectoscope Surg Endosc 17 1292–1297 Occurrence Handle1:STN:280:DC%2BD2c7ks1Kruw%3D%3D Occurrence Handle10.1007/s00464-002-8727-8 Occurrence Handle12739122
B Mentges G Buess G Effinger K Manncke HD Becker (1997) ArticleTitleIndications and results of local treatment of rectal cancer Br J Surg 84 348–351 Occurrence Handle1:STN:280:DyaK2s3jt1Whtg%3D%3D Occurrence Handle10.1002/bjs.1800840324 Occurrence Handle9117305
CC Nduka PA Super JR Monson AW Darzi (1994) ArticleTitleCause and prevention of electrosurgical injuries in laparoscopy J Am Coll Surg 179 161–170 Occurrence Handle1:STN:280:DyaK2czhvFGrug%3D%3D Occurrence Handle8044385
RL Protell DA Gilbert FE Silverstein DM Jensen FM Hulett DC Auth (1981) ArticleTitleComputer-assisted electrocoagulation: bipolar vs monopolar in the treatment of experimental canine gastric ulcer bleeding Gastroenterology 80 451–455 Occurrence Handle1:STN:280:DyaL3M%2FptFOhtw%3D%3D Occurrence Handle7450440
TJ Saclarides (1998) ArticleTitleTransanal endoscopic microsurgery: a single surgeon experience Arch Surg 133(6) 595–599
S Schmidbauer KK Hallfeldt G Sitzmann T Kantelhardt A Trupka (2002) ArticleTitleExperience with ultrasound scissors and blades (UltraCision) in open and laparoscopic liver resection Ann Surg 235 27–30 Occurrence Handle10.1097/00000658-200201000-00004 Occurrence Handle11753039 Occurrence Handle1422392
LE Smith ST Ko T Saclarides P Caushaj BA Orkin KS Khanduja (1996) ArticleTitleTransanal endoscopic microsurgery: initial registry results Dis Colon Rectum 39 S79–S84 Occurrence Handle1:STN:280:DyaK28vivVCnuw%3D%3D Occurrence Handle10.1007/BF02053811 Occurrence Handle8831552
RJ Steele MJ Hershman NJ Mortensen NC Armitage JH Scholefield (1996) ArticleTitleTransanal endoscopic microsurgery: initial experience from three centres in the United Kingdom Br J Surg 83 207–210 Occurrence Handle1:STN:280:DyaK283ks12ltA%3D%3D Occurrence Handle10.1002/bjs.1800830216 Occurrence Handle8689164
MK Wax C Winslow S Desyatnikova PE Andersen JI Cohen (2001) ArticleTitleA prospective comparison of scalpel versus bipolar scissors in the elevation of radial forearm fasciocutaneous free flaps Laryngoscope 111 568–571 Occurrence Handle1:STN:280:DC%2BD3M3msF2ntQ%3D%3D Occurrence Handle10.1097/00005537-200104000-00003 Occurrence Handle11359121
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Ayodeji, I.D., Hop, W.C.J., Tetteroo, G.W.M. et al. Ultracision Harmonic Scalpel and multifunctional tem400 instrument complement in transanal endoscopic microsurgery: a prospective study. Surg Endosc 18, 1730–1737 (2004). https://doi.org/10.1007/s00464-003-9331-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-003-9331-2