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.

Local excision, Multifunctional TEM400 instrument, Rectal tumor, TEM, Transanal endoscopic microsurgery, Ultracision Harmonic Scalpel,
Surgical Endoscopy: surgical and interventional techniques
Department of Surgery

Ayodeji, I.D, Hop, W.C.J, Tetteroo, G.W.M, Bonjer, H.J, & de Graaf, E.J.R. (2004). Ultracision Harmonic Scalpel and multifunctional tem400 instrument complement in transanal endoscopic microsurgery: A prospective study. Surgical Endoscopy: surgical and interventional techniques, 18(12), 1730–1737. doi:10.1007/s00464-003-9331-2