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A new instrumental platform for Trans-Anal Submucosal Endoscopic Resection (TASER)
  1. Zacharias P Tsiamoulos1,
  2. Janindra Warusavitarne2,
  3. Omar Faiz2,
  4. Andrew Castello-Cortes3,
  5. Timothy Elliott1,
  6. Simon T Peake1,
  7. Paul Bassett4,
  8. Brian P Saunders1
  1. 1Wolfson Unit for Endoscopy, St Mark's Hospital/Academic Institute, London, UK
  2. 2Department of Colorectal Surgery, St Mark's Hospital/Academic Institute, London, UK
  3. 3Department of Anesthesia/ITU, St Mark's Hospital/Academic Institute, London, UK
  4. 4Statsconsultancy Ltd., Amersham, UK
  1. Correspondence to Dr Zacharias P Tsiamoulos, Wolfson Unit for Endoscopy, St Mark's Hospital/Academic Institute, Watford Road, London HA1 3UJ, UK; ztsiamoulos{at}nhs.net

https://doi.org/10.1136/gutjnl-2015-309643

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    Existing trans-anal approaches for complete excision of large and complex rectal polyps (CRPs) remain suboptimal due to technical complexity and inflexibility leading to the risk of inadequate excision and need for proctectomy, especially when using a single-channel flexible endoscope. Trans-Anal Submucosal Endoscopic Resection (TASER) provides a flexible endo-surgical platform with enhanced visualisation and therapeutic options delivered via an endoscope assisted by simultaneous, dynamic trans-anal retraction devices (Figure 1). Preliminary results in 17 patients with complex and very large (>5 cm) as well as recurrent polyps with severe submucosal fibrosis showed that the application of different endoscopic resection techniques was facilitated (Figure 2).

    Figure 1

    Instrumental triangulation created with one endoscope and two laparoscopic retractors using the GelPoint path device; real time, ‘dynamic’ retraction (lift) of the polyp with the aid of retracting laparoscopic forceps.

    Figure 2

    Complex rectal polyps (CRPs) (lower and mid rectal lesions) excised with Trans-Anal Submucosal Endoscopic Resection-endoscopic submucosal dissection (TASER-ESD) and TASER-ESD/EMR sessions (prior to the excision, post-polypectomy defect and follow-up scar free of recurrence).

    In more detail

    The new platform was employed in 17 consecutive patients (mean age 63 years, 10 men/7 women) between January 2013 and June 2014, referred with CRPs, in a single-centre, observational cohort study. Prior to referral, all patients had had previous failed attempts with conventional endoscopic techniques. TASER involved placing the GelPoint path (Applied Medical, …

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    Footnotes

    • Competing interests None.

    • Provenance and peer review Not commissioned; internally peer reviewed.