Transanal Endoscopic Operation under spinal anaesthesia

Background Transanal Endoscopic Operation (TEO®) for rectal benign lesions and early rectal cancer may provide better oncological outcomes than flexible endoscopy. The major advantage of flexible endoscopy is that it does not require general anaesthesia. This prospective observational study assessed...

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Bibliographic Details
Published in:British journal of surgery 2016-06, Vol.103 (7), p.916-920
Main Authors: Arezzo, A., Cortese, G., Arolfo, S., Bullano, A., Passera, R., Galietti, E., Morino, M.
Format: Article
Language:English
Subjects:
Adenocarcinoma - pathology
Adenocarcinoma - surgery
Adult
Aged
Aged, 80 and over
Anesthesia, Spinal
Feasibility Studies
Female
Humans
Male
Middle Aged
Operative Time
Pilot Projects
Postoperative Complications
Precancerous Conditions - pathology
Precancerous Conditions - surgery
Prospective Studies
Rectal Neoplasms - pathology
Rectal Neoplasms - surgery
Transanal Endoscopic Surgery
Visual Analog Scale
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Summary:Background Transanal Endoscopic Operation (TEO®) for rectal benign lesions and early rectal cancer may provide better oncological outcomes than flexible endoscopy. The major advantage of flexible endoscopy is that it does not require general anaesthesia. This prospective observational study assessed the feasibility and safety of TEO® performed under spinal anaesthesia. Methods The study population comprised eligible consecutive patients who underwent TEO® under spinal anaesthesia with curative or palliative intent for rectal neoplasms larger than 20 mm in diameter or for recurrent lesions of any size. The primary endpoints were feasibility and safety; secondary endpoints were postoperative pain, as measured on a visual analogue scale, heart rate, systolic and diastolic BP, opioid requested, postoperative nausea or vomiting, and urinary retention. Results The study included 50 patients (median age 70 years; 29 men and 21 women). No intraoperative complications occurred. The median duration of operation was 60 (range 20–165) min. No opioids were requested during the perioperative or postoperative period. The median postoperative pain score was 0 at 4, 8, 24 and 48 h after surgery. There were no significant fluctuations in heart rate, systolic and diastolic BP up to 48 h after the procedure (P = 0·379, P = 0·386 and P = 0·617 respectively). Postoperative nausea and vomiting occurred in one patient, and urinary retention in four. Conclusion TEO® under spinal anaesthesia was safe and feasible with no conversions to general anaesthesia. Safe
ISSN:0007-1323
1365-2168
DOI:10.1002/bjs.10082