Gasless transanal endoscopic surgery for rectal adenomas and early carcinomas.

Transansal endoscopic microsurgery (TEM) allows the excision of rectal tumors but is difficult and complex. A new TEM modification simplifying the procedure and reducing its cost is required. Between 1999 and 2004, 128 patients (78 women and 50 men) underwent gasless transanal endoscopic surgery (GTES) without use of a completely closed system by means of laparoscopic equipment. Histological examination revealed 112 adenomas, including 15 with neoplastic changes (6 cases of Tis and 9 cases of T1G1G2), 12 adenocarcinomas (1 case of Tis, 8 cases of T1G1G2, and 1 case of T2G1G2) and 3 carcinoid tumors. There was no operative mortality. One patient had postoperative bleeding. Adenomas recurred in 9 patients (8.3%). The adenocarcinomas demonstrated neither local recurrences nor distal spread. GTES may be considered a safe and effective minimally invasive treatment for patients with large adenomas and early carcinomas of the rectum.