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The aim of the study is analyze the results after Transanal Endoscopic Microsurgery (TEM) and Trans-Anal Minimally Invasive Surgery (TAMIS) for rectal cancer in terms of Quality of Life (QoL) and anorectal function.The authors have conducted a review of the literature through the PubMed database using the following keywords: "quality of life", "rectal cancer", "transanal surgery", "TEM" and "TAMIS".Six and five studies were included on TEM and TAMIS, respectively, for a total of 619 patients with a follow up of up to five years. QoL and anorectal function were evaluated by questionnaires and anorectal manometry in four out of eleven studies. At postoperative evaluation, patients reported temporary changes (from 3 weeks to 36 months) but no long-term effects on anorectal function and QoL. There were no differences in the postoperative functional outcome between surgery with rigid (TEM) or soft (TAMIS) devices. Some of the studies reported postoperative changes at manometry that were not clinically confirmed by the questionnaires.During TEM and TAMIS the risk of pelvic autonomic nerves damage, that may compromise urinary and sexual function and the risk of permanent sphincter damage with the need to perform a stoma, are very low.Quality of life and anorectal function after TEM or TAMIS for the treatment of rectal tumors are good with no postoperative sequelae at mid-term follow up.Quality of Life (QoL), Rectal cancer, Transanal surgery, Transanal Endoscopic Microsurgery (TEM), Trans-Anal Minimally Invasive Surgery (TAMIS).L’obiettivo della presente revisione della letteratura è quello di analizzare i risultati in termini di qualità di vita e funzione anorettale dopo Transanal Endoscopic Microsurgery (TEM) e Trans-Anal Minimally Invasive Surgery (TAMIS) nel trattamento dei tumori del retto. Gli autori hanno condotto una revisione della letteratura attraverso il database PubMed usando le seguenti parole chiave: “quality of life”, “rectal cancer”, “transanal surgery”, “TEM” e “TAMIS”.Sei e cinque studi, rispettivamente, sono stati inclusi riguardanti la TEM a la TAMIS per un totale di 619 pazienti con un follow up fino a 5 anni. La qualità di vita e la funzione anorettale sono state valutate mediante questionari e manometria anorettale in quattro studi su undici. Nella valutazione postoperatoria della funzione anorettale e della qualità di vita i pazienti hanno riportato modificazioni temporanee (da 3 settimane fino a 36 mesi) ma non effetti a lungo termine. Non ci sono state differenze nei risultati funzionali postoperatori tra la chirurgia con piattaforma rigida (TEM) o morbida (TAMIS). Alcuni studi riportano qualche alterazione alla manometria postoperatoria che comunque non viene confermata dai questionari.Durante la TEM e la TAMIS, il rischio di danno dei nervi pelvici autonomi, che può compromettere le funzioni urinarie e sessuali, e il rischio di danni allo sfintere con la necessità di confezionare una stomia, sono molto bassi.La qualità di vita e la funzione anorettale dopo TEM e TAMIS per il trattamento dei tumori del retto sono buoni, senza sequele postoperatorie ad un follow up a medio termine.

Transanal endoscopic microsurgery (TEM) is a minimally invasive technique that was introduced by Buess in the early 1980s. The TEM procedure employs a dedicated rectoscope with a 3D binocular optic and a set of endoscopic surgical instruments. Since the beginning its advantages have been evident: magnification of the operative field, better access to proximal lesions with lower margin positivity and fragmentation over traditional transanal excision techniques. A non-systematic literature search was performed in the PubMed database to identify all original articles on rectal cancer treated by TEM. Only series including at least ten cases of adenocarcinoma with two years' mean minimum follow-up and published in English were selected. Nowadays more than two decades of scientific data support the use of TEM in the treatment of selected patients with non-advanced rectal cancer. This paper describes the indications and the surgical technique of TEM in the treatment of rectal cancer.

The authors present five cases (three female, two male, mean age 50.8) of cholecystoduodenal fistula incidentally discovered during laparoscopic cholecystectomy and treated by laparoscopic approach. The laparoscopic technique adopted is described and all patients recovered promptly with no immediate or long-term post-operative complications. Discharge from the hospital was after 4.5 days, and after 6 months follow-up all patients were in good clinical condition. These results indicate that when the surgeon is skilled in advanced laparoscopic operative techniques such as duodenal mobilization and intracorporeal suturing and knotting, cholecystoduodenal fistula can no longer be considered a contraindication for laparoscopic treatment.

Performing both laparoscopic cholecystectomy and choledocholithotomy during the same operative procedure for both suspected and unsuspected stones is an attractive alternative to preoperative endoscopic retrograde cholangiopancreatography and stone removal or to conversion of the laparoscopic procedure to open common duct exploration. During laparoscopic exploration, intracorporeal suture and knot-tying may be tedious. We thus developed a technique of suture of the choledochus that avoids the use of knots and avoids placing metal clips in contact with the common bile duct. This technique was accurate, fast, and easily controlled in eight of 21 patients, and no major complications or mortality occurred.

Rectovesical Fistula (RVF) is a rare major surgery complication. Despite different techniques have been proposed as yet there is still no standard treatment. Transanal Endoscopic Microsurgery provides a magnified three-dimensional vision and it is less invasive than the traditional surgical procedure used in RVF treatment.A 62 years-old man, who developed a rectovesical fistula after laparoscopic radical prostatectomy, underwent TEM-assisted RVF repair by full-thickness excision and both bladder and rectal wall suture. The patients had a temporary ileostomyThe patient could ambulate on day one, was fed on day three and was discharged on day 10 with the indwelling bladder catheter left in place. The ileostomy was taken down and the catheter removed three months later when colonoscopy and cystoscopy showed no rvf recurrence.From 2004, only ten cases of TEM-assisted treatment of RVF are reported with three recurrences and good results even in patients who had already undergone previous surgical attempts. TEM is safe and effective. It provides a tension free suture line on healthy tissue with adequate hemostasis and it may be a good alternative in the treatment of rectovesical fistula.Endoscopic Surgery, Microsurgery, Recto-vesical Fistula, Transanal Endoscopic.Le fistole rettovescicali sono una complicanza rara della chirurgia maggiore. Nonostante il corso degli anni siano state proposte diverse tecniche chirurgiche, non vi è ancora un trattamento standard e riconosciuto. La Transanal Endoscopic Microsurgery (TEM) permette di operare in un campo operatorio magnificato e tridimensionale; inoltre è una tecnica meno invasiva rispetto agli approcci tradizionali usati nel trattamento delle fistole rettovescicali.Abbiamo sottoposto ad intervento chirurgico di riparazione mediante TEM un uomo di 62 anni, portatore di ileostomia, il quale ha sviluppato una fistola rettovescicale dopo prostatectomia radicale laparoscopica. L’intervento ha previsto l’escissione a tutto spessore del tessuto sclerotico intorno alla fistola e la sutura della parete vescicale e della parete del retto.Il paziente ha ripreso la deambulazione in prima giornata; è stato in grado di alimentarsi in terza giorgiornata ed è stato dimesso in decima giornata con il catetere vescicale in sede. Tre mesi dopo una colonscopia e una cistoscopia hanno dimostrato l’assenza di recidiva e la ricanalizzazione intestinale è stata, quindi, ripristinata tramite intervento di chiusura di ileostomia e il catetere vescicale è stato rimosso.In Letteratura, dal 2004 a oggi, sono stati riportati solo dieci casi di trattamento di fistula rettovescicale, mediante TEM, con tre casi di recidiva. Sono stati riportati buoni risultati anche nei pazienti che avevano già subito precedenti tentativi di riparazione chirurgica. La TEM si è dimostrata essere sicura ed efficace; permette l’esito di una linea di sutura priva di tensione su tessuto sano con emostasi adeguata e sembra essere un’ottima alternativa, rispetto alle metodiche tradizionali, nel trattamento delle fistole rettovescicali.

Aim of this study was to report the authors' experience with the anterior transperitoneal approach, and with an anterior submesocolic approach in case of left sided lesions.From January 1994 to January 2011, 122 males and 170 females with a mean age of 50.7 years (range: 19-84) underwent laparoscopic adrenalectomy (LA) at 2 centers in Ancona and Rome (Italy) (that follow the same protocol). Fifteen patients underwent bilateral LA, the anterior transperitoneal approach was used in 233 cases (79.8%) and the anterior submesocolic in 59 (20.2%). One hundred and two patients had Conn's syndrome, 51 miscellaneous lesions, 55 Cushing's syndrome, 47 incidentalomas, 46 pheochromocytoma, 2 metastatic masses, 2 myelolipomas and 2 adrenogenital syndromes. The lesions had a mean diameter of 3.24 cm (range: 0.5-10).Mean operating time was 120 minutes (range: 30-390). Conversion to open surgery was required in 13 cases (4,45%). Blood pressure and heart rate were stable during the operation. There were 5 major complications. Mobilization and resumption of diet occurred on the first postoperative day. Mean hospital stay was 4.32 days (range: 2-30).Early identification and ligature of the adrenal vein, with minimal gland manipulation, are the major advantages, especially in case of pheochromocytoma.Adrenal masses can be successfully treated using a laparoscopic transperitoneal anterior approach, in presence of a suitable anesthesiological and surgical team's experience.Adrenal tumors, Laparoscopic adrenalectomy, Pheochromocytoma.