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.

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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