Статті в журналах з теми "Mininvasive surgery"

Urinary stress incontinence is often related to cystocele, hence treatment cannot exclude correction of the latter. The authors have treated 2nd-3rd grade cystocele secondary to central impairment using a mininvasive technique consisting of a vaginal flap suspended anteriorly to the pubic tubercles, according to the traditional “Vesica kit” procedure, and posteriorly to the iliopubic branches in line with the Cooper ligaments using “Vesica kit” screws inserted through the abdominal wall under videolaparoscopy after creating a pneumo-Retzius space. Whenever a pneumo-Retzius cannot be created due to previous pelvic surgery, the same operation may be performed either through a small sovrapubic incision or by inserting 4 screws in line with the pubis. After 1 year the 20 operated patients show satisfying results with good prospects, but a longer follow-up is necessary to confirm these results. The aim of this study is to describe a mininvasive surgical technique for treating 2nd-3rd grade cystocele, associated or not with urinary stress incontinence.

Background and objectives: The Gold-Standard treatment for Advanced Epithelial Ovarian Cancer remains cytoreductive surgery followed by systemic chemotherapy. Surgery can be performed either by an open or minimally invasive approach (MIS), although the former remains the most widely used approach. Recently, Van Driel et al. proved that adding 100 mg/m2 of Cisplatin in Hyperthermic Intraperitoneal Chemotherapy (HIPEC) at Interval Debulking Surgery (IDS) gives a disease-free survival (DFS) advantage. Similarly, Gueli-Alletti et al. demonstrated how the MIS approach is feasible and safe in IDS. Moreover, Petrillo et al. reported pharmacokinetic profiles with a higher chemotherapy concentration in patients undergoing HIPEC after MIS compared with the open approach. Therefore, the following review investigates the oncological and clinical safety consequences of the association between MIS and HIPEC. Methods: Following the recommendations in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, we systematically searched the PubMed and Scopus databases in April 2022. Studies containing data about oncological and safety outcomes were included. We registered the Review to the PROSPERO site for meta-analysis with protocol number CRD42022329503. Results: Five studies fulfilled inclusion criteria. 42 patients were included in the review from three different Gynecological Oncological referral centers. The systematic review highlighted a Recurrence Rate ranging between 0 and 100%, with a 3-year Platinum-Free Survival between 10 and 70%. The most common HIPEC drug was Cisplatin, used at concentrations between 75 and 100 mg/m2 and at an average temperature of 42 °C, for 60 to 90 min. Only 1 Acute Kidney Insufficiency has been reported. Conclusions: The scarcity of clinical trials focusing on a direct comparison between MIS and the open approach followed by HIPEC in EOC treatment does not make it possible to identify an oncological advantage between these two techniques. However, the safety profiles shown are highly reassuring.

Pancreatic traumatic injuries should be managed by multidisciplinary approach. Standard redo surgery can be avoided or supported by innovative mininvasive approaches both endoscopically and/or radiologically. Pancreatic endotherapy has an increasing role in the management of pancreatic injuries. Understanding the pathophysiology of pancreatic leak is crucial to guide the treatment. Endoscopic treatment must be tailored on the type and site of pancreatic fistula to achieve the optimal clinical outcome: there is not a one-way standard treatment but the best treatment for different types of pancreatic injuries considering both retrograde and endoscopic ultrasound (EUS)-guided approaches.

In the last years a wide range of new technique offers the possibility to have R0 resection in colorectal cancer. We report our experience about Single Port Laparoscopic Surgery (SPL) for not advanced right colon cancer and about pelvectomy with cilindric Abdominal Perineal Resection (APR) for advanced rectal cancer. SPL offer mainly cosmetic advantages but also quicker recovery. No touch technique with adequate surgical margin and lymphectomy were respected. Operative time of SPL was 85- 115 minutes, the incision was 5 cm long. There were no complications. Length of hospital stay was 4-6 days. With advanced pelvic cancer, pelvic exenteration with en-bloc resection is indicated. Then we propose a case of a 55 years old woman with a pelvic recurrence from a metastatic rectal cancer involving the right obturator fossa, the vaginal stump, the right ureter. Modern surgical technique give us the chance to offer the most appropriate oncologic surgical treatment.

Objective: We describe an original minimally invasive penile plication technique with scrotal or infrapubic access, not requiring circumcision, for penile curvature of different severity and types. This technique can be used to correct both congenital and acquired curvatures, mono or bidirectional deformities. Materials and methods: Between 2012 and 2018 we treated 134 patients suffering from congenital curvature (33) and acquired curvature from Peyronie's disease (101). The average curvature was 62.2° (± 30.4°). Preoperative evaluation included prostaglandin E1 injection with photographic documentation and measurement of penile angulation, administration of IIEF- 15, vasoactive penile Doppler ultrasound, analysis of thermal and vibratory sensitivity with Genito-Sensory-Analyzer (GSA) and assessment of nocturnal penile stiffness with Rigiscan, performed twice, for a detailed evaluation of patient’s erectile function. Scrotal access was performed in patients with dorsal and/or lateral penile curvature; the infrapubic access was performed in patients with ventral curvature. After preparation and incision of Colles’ fascia, penis was partially degloved and an original plication technique called "binary corporoplasty" was performed at the site or sites established at preoperative assessment, with non-resorbable synthetic multifilament (Premicron®) suture. Results: Complete correction of penile curvature was achieved in 96.8 % of patients. No major complications were reported, and no patients suffered worsening in erectile function or in penile sensitivity. The average shortening of convex side was 1.65 cm (± 0.7 cm) and all patients report easy intercourse after correction. The average time of surgery was 46 minutes (± 11 min) and all procedures were performed as a day-hospital or ambulatory settings, with local anesthesia and light sedation. Overall satisfaction rate is 96%. Conclusions: This is a simple and rapid technique that perfectly corrects even the most severe and complex penile curvatures. In comparison to traditional techniques, such as Nesbit procedure, this technique is associated with low morbidity, a very low recurrence rate and a great aesthetic results. Aesthetic and functional patients’ satisfaction was excellent.

Background: Open partial laryngeal surgery (OPLS) represents a wide array of procedures that can be fitted to treat different types of laryngeal cancer (LC). We would like to present our 30-years’ institutional experience, to analyze survival outcomes and to critically discuss prognostic factors. Methods: We reviewed all cases of OPLS performed at our Institution from 1982 to 2016 for LC. Survival analysis by Kaplan–Meier estimate was performed and prognostic variables by multivariate analysis were identified. Results: Mean follow-up time was 68.3 months, 30-day mortality 0.2%, subsequent functional total laryngectomy (TL) was 1.01%. Over 80% of cases were stage I to II. We had 25 local, 62 regional and eight distant recurrences. Local control was 94.9%, overall survival (OS) was 83.4% and disease-specific survival (DSS) was 87.7%. The two major risk factors significantly associated with the risk of death were cT and cN stage. CONCLUSIONS: We have confirmed that OPLS represents an oncologically sound option in the treatment of LC despite the emergence of non-surgical strategies and new transoral mininvasive techniques. Our results highlight that accurate staging, correct selection of the patient and a strong surgical expertise are of paramount importance in this type of surgery.

Introduction. The method of mininvasive percutaneous cryoablation is applied in the tumor lesions of bones for the purpose of local control and pain syndrome relief. In the case of chest bone destruction, such procedures are accompanied by a risk of damage to the thoracic and abdominal organs, as well as large vessels. This article discusses the peculiarities of percutaneous puncture cryoablation in patients with rib metastatic lesions.Aim. To analyze the methodological aspects of percutaneous cryoablation in patients with rib metastatic lesions and to clarify puncture stereotactic accesses.Materials and methods. The procedure was performed in 11 patients with oligometastatic bone lesions. The size of rib lesions varied from 7 to 55 mm. Surgery was performed in a CT operating room under endotracheal anesthesia. A nitric cryosystem with reusable probes of a diameter varying from 1.5 to 3.0 mm was used. The cryoablation included two cycles of cooling down to the target temperature of –190 °C with 10- and 6-min exposure, respectively.Results and discussion. As a result, optimum puncture accesses for the installation of cryoprobes in tumoral rib destruction, including tangential and perpendicular ones, were proposed. At the tangential access, the cryoprobe can be placed both directly into the tumor lesion (intraosseous variant) and into soft tissues along the bone at the lesion level (paraosseous variant). The follow-up period after the procedure varied from 3 to 27 months (11.4 ± 5.6 months). In 3 cases, the formation of a pathological fracture at the level of the ablated lesion was recorded. The local control of the tumoral process was achieved in 10 patients, a relapse in the ablation zone was noted in one case 3 months after the procedure.Conclusion. Due to the use of the described accesses, as well as the implementation of measures aimed at preventing cold cutaneous lesions, the surgery goals were successfully achieved and complications were avoided in all cases.

Varicocele is present in 15% of males. The incidence increases to 41% in infertile males. Surgery is suggested in oligo-astenospermia and/or hypotrophic testis. The kind of surgery is controversial: “low” or “high” varicocelectomy (Palomo, Ivanissevich), percutaneous sclerotherapy or laparoscopy.

Abstract Background Oesophagectomy is the mainstay of curative treatment for oesophageal cancer and post-oesophagectomy diaphragmatic hernia (PODH) represents a potentially life-threatening surgical complication characterized by an underestimated occurrence rate and unknown related risk factors. This study analyses the experience of two tertiary designated centers in order to evaluate key elements concerning development and treatment of PODH. Methods A cohort of consecutive patients affected by a clinically resectable oesophageal cancer (any T, any N and M0) underwent Ivor-Lewis oesophagectomy between March 1997 and April 2017 according to three different approaches: totally open incision procedure (OILO), hybrid (HILO) and totally mininvasive to esophagectomy (MILO). All patients were retrospectively observed in the context of a postoperative calendarised follow-up in order to record the incidence and postrepair results of PODH. Results 414 patients underwent Ivor-Lewis oesophagectomy for cancer and 22 (5.3%) developed PODH within a median follow-up period of 16 months (6 - 177). Surgical repair was generally applied by the mean of laparoscopic cruroplasty (77%) with a conversion rate of 24%. Postoperative morbidity did not include early recurrences but exclusively cardio-pulmonary complications (5 patients) with one case of respiratory failure leading to death. The discharge was reached after a median hospital stay of 6 days (2 - 95) while 3 recurrences (14%) occurred over a median follow-up period of 10.1 months. A wide univariate analysis identified statistically significant associations between PODH occurrence and the administration of preoperative chemoradiotherapy, the complete pathological response (CPR) and a lymph node harvest (LNH) larger than 33 stations (p-value of 0.016, 0.001 and 0.024 respectively). The strong influence of an extended LNH was confirmed by the multivariable analyses (0.026) along with CPR which should however be considered as longer survival-related bias. Conclusion The minimally invasive surgery and the neoadjuvant chemoradiotherapy represent a considerable part of multimodal treatment for oesophageal cancer presenting a not statistically significant association with PODH development while a LNH including more than 33 nodes resulted to be an independent risk factor mirroring the extent of surgical demolition in oesophagectomy. Disclosure All authors have declared no conflicts of interest.

In the scenario of the COVID-19 pandemic, planning of surgical interventions needs to be FO Leiro y col. Recomendaciones COVID-19: videoendoscópica y mininvasiva. Rev Argent Cirug 2020;112(3):239-248 244 adapted and could be modified depending on the new information and on the dynamics of the pandemic phase each region is going through. The situation of human resources and hospital supplies, and the availability of general ward and intensive care unit (ICU) beds should be considered in the decisions. Given the continuous changes in the knowledge of a completely new entity, it is worth mentioning that these recommendations are mainly based on expert recommendations and are subject to modification in view of new scientific evidence of higher quality.

AbstractOsteoid osteoma is the third most common benign bone tumor, with well-known clinical presentation and radiological features. Although surgical excision has been the only therapeutic option for a long time, to date it has been replaced by minimally invasive techniques, which proved satisfactory success rates and low complication occurrence. Therefore, the purpose of this literature review was to describe the main updates of these recent procedures in the field of interventional radiology, with particular attention paid to the results of the leading studies relating to the efficacy, complications, and recurrence rate. Nevertheless, this study aimed to analyze the peculiarities of each reported technique, with specific focus on the possible improvements and pitfalls. Results proved that all mininvasive procedures boast a high success rate with slight number of complications and a low recurrence rate. Radiofrequency ablation is still considered the gold standard procedure for percutaneous treatment of osteoid osteoma, and it has the possibility to combine treatment with a biopsy. Interstitial laser ablation’s advantages are the simplicity of use and a lower cost of the electrodes, while cryoablation allows real-time visualization of the ablated zone, increasing the treatment safety. Magnetic resonance-guided focused ultrasound surgery is the most innovative non-invasive procedure, with the unquestionable advantage to be radiation free.

Aims: Renal vascular malformations, congenital or acquired, are sometimes challenging for urologists and interventional radiologists to resolve. Arterovenous fistulas and pseudoaneuryms are usually embolized by interventional radiologists, with a low rate of complications. We propose a new endourological/interventional radiology technique to treat a source of arterovenous bleeding coming from a renal calyx in a minimally invasive way. Methods: A combined endourological and interventional radiology procedure is described, using a Flexible Fiberoptic Ureteroscopes to undertake a retrograde intrarenal surgery (RIRS) to identify the source of bleeding; subsequently the VortX Coil® is inserted through a microcatheter to stop the bleeding and the correct position of the VortX coil is evaluated. Furthermore, we made a literature research on Pubmed and Medline to look for similar procedures. Results: In case of a renal bleeding that could not be treated by endovascular way, a combined urological and interventional radiology procedure can be undertaken. We did not find similar endourological and interventional radiology procedure on Pubmed and Medline, so this is the first tecnique of endourological closure of a bleeding point using a coil. Conclusion: From our experience this could be a mininvasive technique to solve renal bleedings coming from a calyx that are not found by endovascular approach. Indeed, in our knowledge, the technique here described is the first that provides the use of an endovascular coil by endourological way in renal vascular malformations.

Resumen La resección transanal miniinvasiva ha mejorado los resultados de las resecciones transanales clásicas. Estas técnicas se han difundido en los últimos años debido al desarrollo del TAMIS (trans anal minimally invasive surgery), que consiste en un puerto multicanal transanal por el que se introduce instrumental laparoscópico clásico. Debido a esto, no sólo ha aumentado el número de procedimientos transanales realizados, sino también sus indicaciones, incluyendo un amplio abanico de patologías. En esta publicación destacamos su rol como procedimiento miniinvasivo de exéresis de un adenocarcinoma rectal insuficientemente resecado luego de un procedimiento endoscópico, permitiendo un estudio adecuado de la lesión. Se describirán los principales detalles de la técnica y sus resultados Introducción El equilibrio para lograr un tratamiento adecuado y mantener la calidad de vida ha derivado en el desarrollo de nuevas técnicas y tecnologías. Las técnicas transanales combinadas con el abordaje endoscópico surgen como alternativa a la resección local convencional.(1) En 1988, Buess et al.,(2) describen la microcirugía endoscópica transanal (TEM: transanal endoscopic microsurgery) como ejemplo de cirugía por orificios naturales y posteriormente surge la cirugía endoscópica transanal (TEO: transanal endoscopic operation). Estas técnicas permitieron mejorar la visibilidad y calidad de la resección, así como tratar lesiones rectales más proximales.(3) El TAMIS (trans anal minimally invasive surgery) surge a partir del desarrollo de la cirugía mininvasiva de puerto único (single port). Descrita en 2010 por Atallah y cols.(4) como una alternativa al TEM/TEO, consiste en la utilización de un puerto único multicanal transanal combinado con el uso de instrumental laparoscópico.(5) Esto ha facilitado su desarrollo y permitido ampliar las indicaciones de lesiones pasibles de resección transanal incluyendo: lesiones benignas, tumores neuroendócrinos, tumores del estroma gastrointestinal (GIST), resección con criterio curativo en adenocarcinomas rectales T1, reseccion de tumores T2 (casos individualizados), resecciones no oncológicas en pacientes con elevado riesgo quirúrgico o por elección propia, exéresis biópsica de la “cicatriz” de una lesión rectal luego del tratamiento neoadyuvante.(1) En este caso, destacamos su rol como coadyuvante de la resección endoscópica frente a resecciones insuficientes (superficiales, márgenes insuficientes, fragmentación). Método Se presenta el caso de una paciente de 68 años a la que durante una videocolonoscopia se le reseca un polipo rectal sésil localizado a 7 cm del margen anal (foto 1). El informe histológico refleja la resección endoscópica incompleta de un adenocarcinoma de recto bajo, con infiltración submucosa de 4 mm de profundidad y márgenes de resección comprometidos. Se decide realizar una resonancia nuclear magnética de recto (foto 2) y la resección de espesor parietal total por TAMIS para estudio completo de la lesión. Procedimiento bajo anestesia general. Previamente, ayuno y preparación retrógrada del recto para la correcta visualización de la lesión. Profilaxis antibiótica con Ampicilina-Sulbactam. Paciente en posición ginecológica y Trendelemburg optimizando la visión de la luz rectal. El monitor se coloca hacia la cabeza del paciente, el cirujano entre las piernas a derecha y el asistente a izquierda. El tacto rectal no evidencia lesiones. Esfínter normotónico. Dilatación anal suave para facilitar la colocación del dispositivo y disminuir el riesgo de trauma esfintérico. Introducción del GelPOINT PathÒ plegado, lubricado. Fijación a la piel para evitar su rotación o explusión, minimizando el trauma del canal anal (foto 3). Colocación de la tapa hermética de gel y los tres puertos de acceso. En el puerto central se coloca la óptica y en los otros dos, los instrumentos laparoscópicos. El insuflador se conecta en el trócar más superior para evitar que el flujo de CO2 “salpique” la óptica con el líquido acumulado en el sector declive del recto. Conexión del GelPOINT PathÒ a una bolsa de estabilización para mantener una cavidad estable. Neumorrecto a 12 mmHg. Identificación de cicatriz de polipectomía en cara posterolateral derecha, a 7cm del margen anal. Realce de la lesión con azul de Metileno (foto 4). Marcado circunferencial de la misma con electrobisturí (margen de 1 cm). La resección comienza a la hora 6 avanzando por ambos lados hasta el sector proximal. Esta maniobra facilita la disección del margen en profundidad. Se toma la pieza por mucosa sana para evitar su fragmentación, asegurando una pieza única y con margen adecuado (foto 5). Extracción de la lesión retirando la tapa del dispositivo y se repera para su estudio anatomopatológico (foto 6). Cierre de la brecha rectal con sutura barbada 3-0 (V-Loc TM, Covidien, Mansfield, MA). Postoperatorio sin incidentes. Alta el mismo día. Resultado anatomopatológico: cicatriz inflamatoria sin malignidad. Fotos 1. Se observa la cicatriz de aspecto nacarado, con fibrosis convergente. Foto 2. Obsérvese el engrosamiento mucoso en cara posterolateral izquierda. Foto 3. Colocación de la plataforma y comienzo de la cirugía. Foto 4. Realce de la lesión con azul de Metileno. Foto 5. Comienzo de la disección. Foto 6. Resección completa. Marcado de la pieza para anatomía patológica. Discusión El desarrollo del TEM/TEO, trajo un cambio en la indicación y resultados de la cirugía transanal.(3) Asimismo, permitió el tratamiento de lesiones en todos los sectores del recto y colon sigmoides distal, con mejores resultados que la cirugía transanal convencional. El TAMIS surge como alternativa al TEM/TEO presentando ciertas ventajas: menor costo; plataforma más facil de colocar; uso de instrumental laparoscópico; campo visual de 360º (vs 220º del TEM); no requiere cambios de posición del paciente (con posibilidad de abordaje intraperitoneal combinado) y curva de aprendizaje corta para cirujanos expertos en laparoscopía.(1,3,4,5,6) Además de la resección de tumores rectales, se ha descrito su uso para la reparación de fístulas rectoureterales, hemostasis de lesión de Dielafoy rectal, reparación de fallas de suturas colo o ileorrectales, extracción de cuerpos extraños y abordajes transcolostomía.(7) Actualmente, existe un renovado interés en TAMIS debido al desarrollo de la escisión mesorrectal total transanal (ta-TME) combinado con resección laparoscópica intraabdominal, facilitando la escisión completa del mesorrecto, cuya disección es dificultosa por vía abdominal exclusiva,(6,8) En esta publicación, comunicamos también su valor en la resección de cicatrices rectales de procedimientos endoscópicas insuficientes. En TAMIS, las dos plataformas más utilizadas son: SILS portÒ (Covidien, Mansfield, Massachusetts, EEUU) y GelPoint PathÒ (Applied Medical, Rancho Santa Margarita, California, EEUU).(6) Su material flexible basado en un elastómero termoplástico permite ajustar instrumentos laparoscópicos de diferente tamaño. Se adapta al canal anal disminuyendo la distensión del esfínter y, gracias al material de confección, genera un sistema de sellado que minimiza la pérdida de CO2. La menor longitud en comparación al TEM, permite mayor angulación y movimiento de las pinzas durante el procedimiento. 4,7) Una de las dificultades técnicas relacionadas al TAMIS es la inestablidad del neumorrecto por el flujo pulsátil del insuflador. En los últimos años se han desarrollado dispositivos como el insuflador Airseal TM y las bolsas estabilizadoras de gas, como la que hemos utilizado. Esto crea un neumorrecto estable, evitando el flujo rítmico y el colapso de la luz rectal, facilitando el procedimiento.(9) El neumorrecto suele realizarse a 15 mmHg con flujo alto, para lograr una adecuada distensión.(6) Para la resección con márgenes adecuados, destacamos la utilidad del realce de la lesión con tinción vital como el azul de Metileno.(10) Esto permite diferenciar mejor el área patológica de la mucosa normal, facilitando el marcado de la lesión con un margen seguro de 5-10 mm.(3) La resección en profundidad dependerá del tipo de lesión. En las resecciones anteriores de espesor parietal completo debe tenerse cuidado de no lesionar la vagina, la uretra/próstata. Es preferible la utilización del electrobisturí para visualizar los planos de disección, si bien pueden utilizarse otros métodos de hemostasis. La pieza obtenida debe ser única y marcarse adecuadamente para su estudio anatomopatológico.(6) Un punto controversial es el cierre de la brecha rectal a nivel subperitoneal. Las últimas publicaciones recomiendan que debe intentarse siempre que sea posible. En cirujanos experimentados y centros de alto volumen se observa una tendencia a realizar el cierre parietal. Puede utilizarse una sutura barbada 2-0 o 3-0 que facilita la maniobra.(3) Como ventajas, habría menos complicaciones fundamentalmente hemorrágicas y aumentaría la velocidad de cicatrización. Sin embargo, esto no esta completamente demostrado y el cierre puede ser dificultoso.(6) En cuanto a los resultados, el TAMIS tiene resultados similares a otras técnicas endoscópicas de cirugía transanal. (18) Los porcentajes de resección incompleta o de fragmentación varían según las series, pero son mejores en comparación a la resección local clásica. Se reportan mayores márgenes de resección R0 (88-90% para la resección endoscópica vs 55% local clásica), menor fragmentación (1.4% vs 24%) y menor recurrencia local acumulada (4-6% a 20% vs 29%).(1,3,4) La morbilidad global con las resecciones endoscópicas transanales varía entre el 7 y 31% en distintos reportes. Esta variabilidad depende de los criterios utilizados para su evaluación. Afortunadamente, más de la mitad son leves y no requieren tratamiento.(3) Dentro de las complicaciones más relevantes destacamos: la hemorragia y la incontinencia. La hemorragia es la complicación más frecuente (1-13%) y se asocia a dejar abierta la brecha rectal. Generalmente es leve y se detiene espontáneamente. En cuanto a la incontinencia, se ha reportado una incidencia de 10%, de grado variable. Está dada fundamentalmente por la dilatación anal y colocación de la plataforma.(7) Sin embargo, los últimos estudios han mostrado alteraciones prinicpalmente manométricas sin traducción clínica. Se ha reportado tanto para TEM como para para TAMIS.(5) La dehiscencia de la línea de sutura y el desarrollo de abscesos perirrectales se observa en 5% de los casos. Este porcentaje aumenta en pacientes sometidos a neoadyuvancia. Las lesiones uretrales/vaginales se ven en 5,8%. La perforación intraperitoneal en resecciones altas puede repararse por abordaje transanal o laparoscópico abdominal simultáneo.(3) Otras complicaciones poco frecuentes son: estenosis anal, fístulas rectovaginales, lesiones vasculares y nerviosas, embolia gaseosa, neumoretroperitoneo, retención aguda de orina, dolor, fiebre.(7) Conclusión Gracias a la accesibilidad y familiaridad de los materiales laparoscópicos para el cirujano, el TAMIS ha permitido extender la aplicación de los procedimientos endoscópicos por vía transanal, con una mejor calidad de resección que la técnica transanal convencional. Esto permite ampliar sus indicaciones, como en este caso, que se utilizó para la resección de un tumor rectal luego de una resección endoscópica insuficiente, permitiendo su estudio anatomopatológico completo, definiendo la conducta terapéutica. Bibliografía Moreira A, Zapata G, Bollo C, Morales R, Sarotto L. TAMIS: ¿Un nuevo estándar para el tratamiento de los pólipos de recto? Revisión de la bibliografía y reporte de nuestra experiencia. Rev Argent Coloproct (2019) 30(1): 1-11. Buess G, Kipfmüller K, Hack D, Grüssner R, Heintz A, Junginger T. Technique of transanal endoscopic microsurgery. Surg Endosc (1988) 2(2): 71-75. Rossi G. Relato oficial. Resecciones transanales: pasado, presente y futuro. Rev Argent Coloproct (2019) 30(3): 1-77. Atallah S, Albert M, Larach S. Transanal minimally invasive surgery: A giant leap forward. Surg Endosc (2010) 24: 2200-2205. Villanueva JA, Alarcón L, Jiménez B. Cirugía endoscópica transanal: nuevas alternativas con instrumentos de cirugía laparoscópica convencional. In: http://www.medigraphic.com/cirugiaendoscopica. (2011) 14(4): 174-179. Quinteros F, Thiruppathy K, Albert M. Transanal Minimally Invasive Surgery (TAMIS): operative technique, pitfalls and tips. In: Minimally invasive approaches to colon and rectal diseases: technique and best practices. Ross HM et al. (eds), Springer Science + Buisness Media New York (2015) 25: 283-91. Heras MA, Cantero R. Cirugía transanal a través de puerto único (TAMIS). Revisión frente otras técnicas de excisión endoscópica de lesiones rectales. Rev Argent coloproct (2013) 2: 55-60. Arroyave MC, De Lacy B, Lacy AM. Transanal total mesorectal excision (TaTME) for rectal cancer: step by step description of the surgical technique for a two-teams approach. Eur J Surg Oncol (2017) 43(2): 502-505. doi: 10.1016/j.ejso.2016.10.024.Epub 2016 Nov 20. Waheed A, Miles A, Kelly J, Monson JRT, Motl JS, Albert M. Insufflation stabilization bag (ISB): a cost-effective approach for stable pneumorectum using a modified CO2 insufflation reservoir for TAMIS and taTME. Tech Coloproctol (2017) 21: 897-900. Moreira Grecco A, Dip F, Sarotto L. Methylene blue TAMIS guided procedure facilitates adenomatous polyps resection. In: https://www.sages.org/meetings/annual-meeting/abstracts-archive/methylen-blue-tamis-guided-procedure-facilitates-adenomatous-polyps-resection/.