Transanal Ultrasonically Activated Scalpel Technique for Local Excision of Rectal Tumors

Background: Patients with broad based rectal adenomas and selected patients with T1/T2 low and mid-rectal malignant tumors are candidates for a transanal local excision. Difficulty of dissection due to impaired vision caused by continuous or intermittent bleeding has always been a problem in this operation. Method: We describe a simple technique to improve hemostasis and vision using the laparoscopic ultrasonically activated scalpel for excision of rectal tumors. Results: More than 50 patients were treated with this technique over the last 3 years. The authors have used this technique for broad based rectal lesions, up to 12 cm from the anal verge including adenomas spreading over half the rectal circumference without any complications and virtually no bleeding. Conclusion: The principal advantage of the ultrasonically activated scalpel is its excellent coagulation-cutting effect. The use of this instrument for local rectal excisions has proved feasible and avoids the problems of hemostasis and limited access.