Transanal Endoscopic Operation (TEO) for rectal polyp: submucosal dissection with Ligasure Advance®

In recent years, local treatment procedures have been developed to manage benign lesions of the rectum. This is the case of a superficial tumor of the anal margin located at the lower third of the rectum on its right anterior aspect. The objective of the video is to demonstrate a submucosal resection technique with the Ligasure Advance® device and using the TEO™ system manufactured by Karl Storz.

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Transanal Endoscopic Operation (TEO) for rectal polyp: submucosal dissection with Ligasure Advance®

Authors

J Leroy, J Marescaux

Abstract

In recent years, local treatment procedures have been developed to manage benign lesions of the rectum. This is the case of a superficial tumor of the anal margin located at the lower third of the rectum on its right anterior aspect. The objective of the video is to demonstrate a submucosal resection technique with the Ligasure Advance® device and using the TEO™ system manufactured by Karl Storz.

Classification

clinical cases

Keywords

Transanal Endoscopic Operation, TEO, rectal polyp, submucosal dissection, Ligasure Advance®

Media type

Surgical video

Duration

04'48''

Publication

2009-10

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E-publication

WeBSurg.com, Oct 2009;9(10).
URL: http://www.websurg.com/doi-vd01en2658.htm

Transanal Endoscopic Operation (TEO) for rectal polyp: submucosal dissection with Ligasure Advance®

1. Introduction 00'07''

The objective of this film is to demonstrate a submucosal resection technique with the Ligasure Advance® device and using the TEO™ system manufactured by Karl Storz.

2. Case presentation 00'18''

The surgical indication is a superficial tumor of the anal margin located at the lower third of the rectum on its right anterior aspect as can be seen on these magnetic resonance images.

3. TEO™ system cannula introduction 00'36''

The fist step is the introduction of the first trocar cannula of the TEO™ system. This system allows to simultaneously introduce instruments and insufflate the rectum and introduce a scope for visualization of the rectal ampulla as can be seen here. Here the tumoral lesion is also clearly visible.

4. Polyp infiltration 01'12''

Before starting, we decide to infiltrate the base of this benign-looking polypoid lesion with an adrenalin solution. Then the procedure starts with the opening of the mucosa distal from the pedicle.

5. Submucosal resection with Ligasure Advance® 01'30''

Thanks to a counter-traction, a submucosal resection is performed; hence the entire mucosal wall with the embedded polyp is removed. This maneuver is carried out from caudad to cephalad. The monopolar electrode at the tip of the Ligasure Advance® device is used to dissect the submucosal space. The forceps also allows the use of bipolar current that coagulates the submucosal vessels. Thanks to traction and counter-traction and the use of the forceps as a dissecting instrument, the submucosal division can be pursued ensuring a perfect hemostasis until complete division of the polyp and the mucosa on which it was implanted. Contrary to a complete resection of the wall, this submucosal resection does not require any closure of the incision. The specimen is sent for histological examination.