with Dr. Salvadora Delgado, Dr. Gabriel Diaz Del Gobbo
Our case is a 52 year old female patient with a previous history of HBP, dyslipidemia, hypothyroidism, mild aortic, mitral and tricuspid regurgitation.
No previous surgeries.
Secondary to tenesmus, a colonoscopy was performed finding a flat and large polyp 5 cm from the anal verge which occupied half of the circumference of the rectum and was endoscopically unresectable.
Pathological anatomy was compatible with a tubulovellous adenoma with low-grade dysplasia.
An abdominal CT was performed with no other significant findings.
We decided to perform a TAMIS procedure. The patient was placed in the Lloyd-Davies position. The surgeon stood between the legs with one assistant.
We introduced the GelPOINT Path of Applied transanally and the neumorectum began. We used three 10 mm trocars placed in a triangle. One of them provided a 30° scope, and two served as working channels for the leading surgeon. First we identified the polyp at 5 cm from the anal verge that extended up to 10 cm occupying almost 3/4 of the circumference. Then we marked the outer limits of the lesion using the hook.
After that we started removing it. Polyp resection was performed up to the mesorectum plane. It is important to resect all the polyp en bloc with wide margins to ensure complete removal. We performed resection from the anterior to the posterior using electrocautery in this case, by means of the hook, although occasionally we can use the LigaSure™. Finally we completed the removal of all the polyp.
Now we can see the defect in the rectal wall into the mesorectum plane. We tried to unite both sides of the rectal wall to verify that there was no tension in the suture. Then we made a running suture using V-loc. We started the suture in the middle of the defect and continue to close the right side of the wound.
We then completed the suture closing the left side of the defect in the rectal wall.
Finally we can see the fully sutured rectal wall, ensuring that there is no stenosis in the intestinal lumen.
The surgery took 75 minutes. The patient presented a correct postoperative period. He started oral intake 24 hours after the surgery and left the hospital on the 2nd postoperative day.
Pathological examination described a tubulovellous adenoma with areas of high-grade dysplasia. Tumor size was 6 x 5cm. And the resection margins were disease-free.
The patient remains asymptomatic one year after the revision and he has proctoscopic controls with no signs of recurrence.
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