Transanal single-port surgery for the resection of large polyps.

INTRODUCTION: Transanal endoscopic microsurgery (TEM) is widely used for the excision of both benign and malignant rectal tumours. It is relatively expensive and can be a challenging technique. A recent development in laparoscopic surgery is the single-port technique (single-incision laparoscopic surgery, SILS). The SILS port is a flexible multichannel port for transumbilical laparoscopic surgery. Even though not developed for transanal use the port could be ideal because of its shape and texture. METHODS: 12 patients underwent transanal resection using an SILS port and normal laparoscopic instruments. RESULTS: 10 out of 12 patients were treated successfully with the SILS port. Two polyps were resected using an open transanal technique because the distance between the SILS port and the polyp was too small. The average operative time was 55 min (range 40-80 min). All patients could be discharged on the first postoperative day. There were no major complications. CONCLUSION: Our current data show that transanal surgery using a single port is a relatively easy procedure with operative times comparable to TEM. More surgeons will therefore be able to perform transanal endoscopic surgery.

Emergency aorto-iliac aneurysm surgery with low mortality and morbidity.

The authors present a consecutive series of 27 patients (26 men, one woman), urgently operated for aortic or iliac aneurysm during the period 1986-1994. Mean age was 68 years. Free rupture was found in 16 cases, 8 times a rupture with important retroperitoneal haematoma and fissurisation in 4. There were three ruptures of iliac aneurysms. In two cases arterio-venous fistulisation occurred: one ilio-iliac, another aorto-caval. For two juxta-renal aneurysms, supra-renal crossclamping was necessary and nephroplegia was used. Every reconstruction was done by Dacron prosthesis: a straight tube (47%), an aortobi-iliac (15%) or an aorto-bifemoral bifurcation prosthesis (38%). Mortality was 19% (0.0654 to 0.315, 90% confidence limits) with one intra-operative death. The morbidity was 49%, mostly by respiratory and/or renal complications, and mainly transient in nature.