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Simultaneous transanal endolaparoscopic resection of a large anal canal and low rectal polyps – a video vignette
Author(s) -
Dapri G.,
Cawich S. O.,
Bascombe N. A.,
Bobb A. K.,
Arabadjiev A.,
GomezGaldon M.
Publication year - 2019
Publication title -
colorectal disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.029
H-Index - 89
eISSN - 1463-1318
pISSN - 1462-8910
DOI - 10.1111/codi.14669
Subject(s) - vignette , medicine , anal canal , resection , rectal polyp , general surgery , surgery , rectum , psychology , social psychology
BACKGROUNDLarge rectal polyps can be approached by endoscopic mucosal resection or endoscopic submucosal dissection. A recent application of endoluminal resection, called transanal minimally invasive surgery (TAMIS), has been introduced.VIDEOA 79-year-old man presenting with two large polyps in the anal canal (uTisN0) and low rectum (uTis vs T1N0) was submitted to TAMIS. The patient was placed in the prone jack knife position with the legs apart. The reusable transanal D-Port was introduced into the anus. Exploration showed the presence of a large polyp involving the entire length of the anal canal and part of the lower the rectum and a second large polyp was located 1 cm above the upper extent of the anal lesion in the lower rectum. The anal canal polyp was removed with preservation of the muscular layer; the rectal polyp by resecting the full thickness of the rectal wall. Both mucosal and submucosal flaps were closed by two converging sutures.RESULTSOperating time was 78 minutes for the anal canal polyp and 53 minutes for the low rectal polyp. Perioperative bleeding was 10 cc. The patient was discharged after 1 day. Pathological examination of the resected polyps showed tubulo-villous adenomas with high grade dysplasia but disease-free margins; stage: pTis (8 UICC edition). After 2 years of follow-up the patient remains free of disease.CONCLUSIONSTAMIS for large polyps located in the anal canal and low rectum offers an excellent field exposure, safe en-bloc polypectomy and the facility to achieve an endoluminal closure of the defect. This article is protected by copyright. All rights reserved.