Stereotactic navigation for TAMIS-TME.

Stereotactic navigation allows for real-time, image-guided surgery, thus providing an augmented working environment for the operator. This technique can be applied to complex minimally invasive surgery for fixed anatomic targets. Transanal minimally invasive surgery represents a new approach to rectal cancer surgery that is technically demanding and introduces the potential for procedure-specific morbidity.

Vaginal Access Minimally Invasive Surgery (VAMIS): A New Approach to Hysterectomy.

Vaginal hysterectomy is the original natural orifice operation. Although one of the most common gynecologic operations performed, the surgical approach has not changed significantly during the past century. This article describes a new approach to hysterectomy using vaginal access minimally invasive surgery (VAMIS).

Stereotactic navigation for TAMIS-TME: opening the gateway to frameless, image-guided abdominal and pelvic surgery.

Background: Frameless stereotaxy is an established method for real-time image-guided surgical navigation in neurological surgery. Though this is capable of providing sub-millimeter accuracy, it has not been used by other surgical specialists.

Methods And Procedure: A patient with locally advanced, distal rectal cancer and tumor abutting the prostate was selected for transanal TME using TAMIS, with intra-operative CT-guided navigation to ensure an R0 resection.

Robotic transanal surgery for local excision of rectal neoplasms.

Robotic transanal surgery (RTS) has been a natural evolution of transanal minimally invasive surgery. This video demonstrates how RTS is performed for the full-thickness excision of a malignant rectal polyp, with endoluminal robotic suturing of the rectal wall defect. The general approach to RTS, including the approach to docking of the robotic cart, are also illustrated in video format.

An extended paIn relief trial utilizing the infiltration of a long-acting Multivesicular liPosome foRmulation Of bupiVacaine, EXPAREL (IMPROVE): a Phase IV health economic trial in adult patients undergoing ileostomy reversal.

Background: Opioid analgesics are effective for postsurgical pain but are associated with opioid-related adverse events, creating a significant clinical and economic burden. Gastrointestinal surgery patients are at high risk for opioid-related adverse events. We conducted a study to assess the impact of an opioid-sparing multimodal analgesia regimen with liposome bupivacaine, compared with the standard of care (intravenous [IV] opioid-based, patient-controlled analgesia [PCA]) on postsurgical opioid use and health economic outcomes in patients undergoing ileostomy reversal.

Transanal minimally invasive surgery (TAMIS) for local excision of benign neoplasms and early-stage rectal cancer: efficacy and outcomes in the first 50 patients.

Background: Since its inception in 2009, transanal minimally invasive surgery has been used increasingly in the United States and internationally as an alternative to local excision and transanal endoscopic microsurgery for local excision of neoplasms in the distal and mid rectum. Despite its increasing acceptance, the clinical benefits of transanal minimally invasive surgery have not yet been validated.

Objective: The aim of this study is to assess the adequacy of transanal minimally invasive surgery for the local excision of benign and malignant lesions of the rectum.

Transanal minimally invasive surgery: a giant leap forward.

Background: Our novel approach is a hybrid between transanal endoscopic microsurgery (TEM) and single-port laparoscopy that we have termed TransAnal Minimally Invasive Surgery (TAMIS). We report the clinical application of this technique and present preliminary data that show TAMIS to be an effective tool for resection of both malignant and benign lesions of the rectum.

Methods: Over a 3-month period (May-July 2009) all patients with rectal lesions who were candidates for conventional transanal excision were offered the option to undergo TAMIS resection.

Postoperative surveillance recommendations for early stage colon cancer based on results from the clinical outcomes of surgical therapy trial.

Purpose: Intensive postoperative surveillance is associated with improved survival and recommended for patients with late stage (stage IIB and III) colon cancer. We hypothesized that stage I and IIA colon cancer patients would experience similar benefits.

Patients And Methods: Secondary analysis of data from the Clinical Outcomes of Surgical Therapy trial was performed by analyzing results according to TNM stage; early (stage I and IIA, 537 patients) and late (stage IIB and III, 254 patients) stage disease.

Stapled transanal rectal resection vs. transvaginal rectocele repair for treatment of obstructive defecation syndrome.

Purpose: Stapled transanal rectal resection has been introduced as a new technology for the management of obstructive defecation syndrome. In this study we observed the clinical outcomes for stapled transanal rectal resection as compared with transvaginal rectocele repair for obstructive defecation syndrome.

Methods: This study is a retrospective review of patients who received transvaginal rectocele repair for obstructive defecation syndrome from June 1997 to February 2002 as compared with patients who received stapled transanal rectal resection from June 2005 to August 2007.

Surgeon volume does not predict outcomes in the setting of technical credentialing: results from a randomized trial in colon cancer.

Objective: To test the hypothesis that surgeon volume would not predict short- and long-term outcomes when evaluated in the setting of technical credentialing.

Summary Background Data: Surgical volume is a known predictor of outcomes; the importance of technical credentialing has not been evaluated.

Methods: Fifty-three credentialed surgeons operated on 871 patients in the Clinical Outcomes of Surgical Therapy Study (NCT00002575), investigating laparoscopic versus open surgery for colon cancer.

Prevention of postoperative abdominal adhesions by a novel, glycerol/sodium hyaluronate/carboxymethylcellulose-based bioresorbable membrane: a prospective, randomized, evaluator-blinded multicenter study.

Introduction: Postoperative abdominal adhesions are associated with significant morbidity and mortality, placing a substantial burden on healthcare systems worldwide. Development of a bioresorbable membrane containing up to 23 percent glycerol and chemically modified sodium hyaluronate/carboxymethylcellulose offers ease of handling and has been shown to provide significant postoperative adhesion prevention in animals. This study was designed to assess the safety of glycerol hyaluronate/carboxymethylcellulose and to evaluate its efficacy in reducing the incidence, extent, and severity of postoperative adhesion development in surgical patients.

Laparoscopic management of diverticular disease.

Laparoscopy surgery has achieved wide acceptance for the treatment of benign disease of the colon. A review of the literature regarding the indications, surgical technique, and outcomes of laparoscopic surgery for diverticular disease is presented.

Prospective comparison of laparoscopic vs. open resections for colorectal adenocarcinoma over a ten-year period.

Purpose: The aim of this study was to define the long-term oncologic outcomes of laparoscopic resections for colorectal cancer.

Methods: We analyzed our experience via a prospective, nonrandomized, longitudinal cohort study. The period of study extended from April 1991 to May 2001.

A study to determine the nitroglycerin ointment dose and dosing interval that best promote the healing of chronic anal fissures.

Purpose: The aim of this study was to determine the optimal dose and dosing interval of nitroglycerin ointment to heal chronic anal fissures.

Method: A randomized, double-blind study of intra-anally applied nitroglycerin ointment (Anogesic) was conducted in 17 centers in 304 patients with chronic anal fissures. The patients were randomly assigned to one of eight treatment regimens (0.